Kennedy et al developed a model for identifying an elderly patient in the Emergency Department (ED) 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 Beth Deaconess Medical Center in Boston.
Patient selection: age >= 65 years in the ED
Parameters
(1) age of the patient in years
(2) history of dementia
(3) history of transient ischemic attack (TIA) or ischemic stroke
(4) respiratory rate in breaths per minute
(5) suspected infection (based on physician diagnosis or administration of antibiotics)
(6) intracranial hemorrhage diagnosed in the ED
|
Parameter |
Finding |
Points |
|
age in years |
65 to 69 years |
0 |
|
|
70 to 79 years |
1 |
|
|
80 to 89 years |
2 |
|
|
>= 90 years |
3 |
|
history of dementia |
no |
0 |
|
|
yes |
3 |
|
history of TIA or ischemic stroke |
no |
0 |
|
|
yes |
2 |
|
respiratory rate |
<= 20 breaths/minute |
0 |
|
|
> 20 breaths/minute |
2 |
|
suspected infection |
no |
0 |
|
|
yes |
2 |
|
intracranial hemorrhage |
no |
0 |
|
|
yes |
5 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• The higher the score the greater the risk for delirium.
|
Score |
Risk of Delirium |
|
0 to 2 |
low (4%) |
|
3 or 4 |
moderate (12%) |
|
5 to 17 |
high (29%) |
Performance:
• The area under the ROC curve was 0.77.
Specialty: Neurology
