An app-directed protocol was found to be feasible, brief, and accurate for diagnosing delirium among inpatients, according to a study published in Annals of Internal Medicine. Edward R. Marcantonio, MD, and colleagues tested a brief, app-directed protocol in real-world practice compared with a research reference standard delirium assessment (RSDA). General medicine inpatients (N=527), 35% of whom had pre-existing dementia, underwent RSDA on two study days. An ultra-brief, two-item screen (UB-2) for delirium was performed by certified nursing assistants (CNAs), while a two-step protocol, including the UB-2 followed by the 3-Minute Diagnostic Interview for the Confusion Assessment Method for those with a positive screen, was performed by physicians and nurses. Delirium was diagnosed in 17% of RSDAs and in 22% of patients. The sensitivities for UB-2 were 88%, 87%, and 82% when administered by CNAs, nurses, and physicians, respectively, while specificities varied from 64% to 70%. Overall accuracy rates of the protocol were 89% and 87% for nurses and physicians, respectively, with sensitivities of 65% and 63% and specificities of 93% and 91%. For moderate-to-severe delirium, the two-step protocol sensitivity was 78%.
