TL;DR: start here
Commentary. These are the author’s interpretations of the cited evidence. Disclosures.
There are many delirium tools, but they do different jobs. Start with what you need to assess and where the patient is receiving care.
Episodic tools help assess for delirium at a particular time: on presentation, at a transition in care, or when someone notices a change. Monitoring tools organise repeated observations for new delirium during continuing care. Severity scales measure symptoms over time. Arousal scales assess alertness or sedation. Other instruments describe distress and experience.
Fewer tools have evidence of routine use. A large-scale general-hospital review included 4AT, CAM, bCAM, DOSS, Nu-DESC and ICDSC. CAM usually means the four-feature short form. The long CAM has ten items. CAM-ICU also has routine ICU evidence. RASS is used there to assess arousal and sedation. SQiD has smaller implementation reports.
Validation studies and routine-care studies answer different questions. Tools can perform well in research yet be poorly used in practice. Completion rates, positive results and diagnostic accuracy must be considered separately.
Choose a tool for your patient group and task. Check training, time, access and the evidence. Decide who will act on a concerning result. Examine whether the approach works in your service, including what happens to patients after a positive assessment.
Sources: Penfold et al. (2024), van Eijk et al. (2011), Vasilevskis et al. (2011) and McCleary and Cumming (2015). The general-hospital review searched to December 2022. This is not a complete global implementation census.