Using Confusion Assessment Method for Detection Delirium among Hospice Patients: Screening or a Diagnostic Instrument?

Identification of delirium can be difficult, because the symptoms can be mistaken for otherconditions like depression, dementia and so on. Our hypothesis is that patients withhyperactive delirium (heightened arousal, restlessness and agitation) are easier recognisedthan the hypoactive delirium (Patients withdrawn, quiet and sleepy). A Danish nationalGuideline (2013) recommends systematic screening by the Confusion Assessment Method(CAM), which is validated as having high sensitivity and specificity.Aims: The aim of this study was to evaluate the use of CAM, as a diagnostic tool, in ourHospice.Methods: A retrospective studyFrom 1.4.2014, all patients admitted to our hospice were screened with CAM every eveningas well as if the patient was suspected of having delirium.The patient notes of 61 patients admitted to Hospice from 1.4. until 20.7.2014 wereexamined. The results of the CAM score were registered and compared withdocumentations on psycho-social conditions.Results: Out of 61 patients, 2 were excluded because the CAM score wasn’t done. 59 patientswere included. 19 patients were in delirium according to the CAM score (32%).Documentations on psycho-social conditions detected that 25 patients were diagnosed andtreated for delirium (42%). 4 of the 6 patients, who weren’t identified by CAM, were interminal delirium (< 3 days to death) and 2 patients were assessed to have a hypoactivedelirium. With a total of 4 hypoactive delirium patients in the study, only 50 % werediscovered by the CAM.Conclusion: Our once a day screening by CAM, during the evening, did not find all patientswith delirium. Screening when delirium was clinically suspected was more effective atidentifying delirium.In the future it’s still important to focus on the hypoactive condition, which is difficult toidentify because the symptoms can be confused with e.g. fatigue of the terminally ill.