THE RATIONAL CLINICIAN’S CORNER CLINICAL EXAMINATION Value of Bedside Instruments Camilla L. Wong, MD, MHSc, FRCPC Context Delirium occurs in many hospitalized older patients and has serious conse- Jayna Holroyd-Leduc, MD, FRCPC quences including increased risk for death and admission to long-term care. Despite its importance, health care clinicians often fail to recognize delirium. Simple bedside David L. Simel, MD, MHS instruments may lead to improved identification. Sharon E. Straus, MD, MSc, FRCPC Objective To systematically review the evidence on the accuracy of bedside instru- ments in diagnosing the presence of delirium in adults. CLINICAL SCENARIO Data Sources Search of MEDLINE (from 1950 to May 2010), EMBASE (from 1980 to An 85-year-old man with non–small cell May 2010), and references of retrieved articles to identify studies of delirium among in- lung cancer was admitted yesterday to patients. the oncology ward for treatment of Study Selection Prospective studies of diagnostic accuracy that compared at least pneumonia. He started antibiotics and 1 delirium bedside instrument to the Diagnostic and Statistical Manual of Mental Dis- supplemental oxygen. Prior to hospi- orders–based diagnosis made by a geriatrician, psychiatrist, or neurologist. talization, he lived independently in the Data Synthesis There were 6570 unique citations
JAMA – American Medical Association
Published: Aug 18, 2010
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