Silva et al reported the Recognizing Delirium in Geriatric Emergency Medicine (REDEEM) score to risk stratify elderly patients in the Emergency Department for risk of delirium. This can help to identify a patient who may require further assessment. The authors are from the Mayo Clinic.
Patient selection: age >= 75 years in the Emergency Department
Parameters:
(1) arrival via ambulance (EMS)
(2) altered mental status chief complaint at triage
(3) ESI level, from 1 to 5
(4) oxygen saturation in percent
(5) systolic blood pressure in mm Hg
(6) diastolic blood pressure in mm Hg
(7) respiratory rate in breaths per minute
(8) confusion or disorientation identified during fall risk assessment
(9) altered urinary or fecal elimination identified during fall risk assessment
(10) history of seizure disorder
|
Parameter
|
Finding
|
Points
|
|
arrival by ambulance
|
no
|
0
|
|
|
yes
|
1
|
|
altered mental status
|
no
|
0
|
|
|
yes
|
18
|
|
ESI level
|
< 3
|
0
|
|
|
>= 3
|
-3
|
|
oxygen saturation
|
>= 92%
|
0
|
|
|
< 92%
|
2
|
|
systolic blood pressure
|
>= 111 mm Hg
|
0
|
|
|
< 111 mm Hg
|
2
|
|
diastolic blood pressure
|
<= 99 mm Hg
|
0
|
|
|
> 99 mm Hg
|
1
|
|
respiratory rate
|
< 16 breaths per minute
|
3
|
|
|
16 to 24 bpm
|
0
|
|
|
> 24 breaths per minute
|
6
|
|
confusion or disorientation
|
no
|
0
|
|
|
yes
|
25
|
|
altered elimination
|
no
|
0
|
|
|
yes
|
8
|
|
history of seizures
|
no
|
0
|
|
|
yes
|
4
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -3
• maximum score: 66 (cannot have systolic < 111 mm Hg and diastolic > 99 mm Hg)
• A score >= 11 indicates high risk of delirium in the ED with sensitivity 0.84 and specificity 0.87.
• A cutoff score >= 5 for high risk has a sensitivity of >= 5.
Performance:
• The area under the ROC curve is 0.90.
