If you take a wander through your local hospital emergency department, you will generally not find any similarity to what you see on TV. It will not look like an episode of ‘ER’, with ambulances pulling up at breakneck speed and doctors yelling instructions in an attempt to save a life. Generally, the atmosphere is more sedate and if you look around there is one thing that becomes very clear-the general atmosphere of confusion. No, I am not talking about the medical staff but rather about the patients. Confused, delirious patients are very common in hospital and while diagnosing and treating delirium may not sound sexy, it is unbelievably important. There are lots of causes for delirium including medication side effects, infection and stroke but one of the most difficult things to do is to actually be able diagnose delirium effectively. Sounds easy, but it is far from it.
In this issue of JNNP, O’Regan and colleagues have undertaken an interesting study looking at simple ways of assessing delirium http://jnnp.bmj.com/content/85/10/1122.abstract . Their study shows that a simple test, naming the months of the year backwards, was a reliable way of diagnosing delirium. The screening tests were undertaken by junior medical doctors, who are the people that are generally faced with the initial assessment of delirious patients.
This is an interesting paper that has very clear and immediate clinical application.