Delirium: A Test of the Diagnostic and Statistical Manual III Criteria on Medical Inpatients

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Abstract
Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field‐tested the Diagnostic and Statistical Manual III (DSM‐III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM‐III criteria, 19 more patients than were reported by the primary clinician. Seven delirious patients were less than 65 years of age (range, 32 to 64 years). Sixty‐five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P <.0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM‐III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM‐III criteria to identify delirious patients for an immediate evaluation and treatment.

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