Douglas et al reported the AWOL tool for identifying a patient who may be at risk for delirium. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of California San Francisco and the San Francisco Veterans Affairs Medical Center.
Patient selection: hospitalized adult > 50 years of age without delirium on admission
Parameters:
(1) age (A)
(2) ability to correctly spell the word "world" backward (W)
(3) oriented to location (state, county, city, hospital name, floor; O)
(4) nursing assessment of illness severity (L)
Parameter
Finding
Points
age in years
< 80 years of age
0
>= 80 years of age
1
spell "world" backwards
able
0
unable
1
awareness
oriented
0
disoriented
1
nursing illness severity
not ill or mildly ill
0
moderately ill, severely ill, moribund
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the greater the risk for delirium.
Total Score
Percent Delirious
0
2%
1
4%
2
14%
3
20%
4
69%
Performance:
• The area under the ROC curve was 0.81 in the derivation cohort and 0.69 in the validation cohort.
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