Book Description

The period of acute recovery following acquired brain injury has been referred to as post-traumatic amnesia despite the recognition that the scope of impairment extends far beyond memory. Conversely, delirium is a neuropsychiatric disorder with a broad constellation of symptoms, including cognitive, psychiatric and behavioral impairments, which may be precipitated by a wide range of etiologies. Recent understanding of acute recovery following acquired brain injury suggests that these cognitive and behavioral impairments may be managed more appropriately if they were considered instead as symptoms of delirium. The advantages of this conceptualization are clear: delirium is a condition which accounts for the breadth of the symptoms ignored by the concept of post-traumatic amnesia and for which there are clear treatment recommendations. To improve recognition of the condition in medical rehabilitation settings, a brief screening tool was developed. The tool was comprised of three items demonstrated to be commonly impaired in patients with delirium and which were hypothesized to reflect core features of the disorder. The screening tool was compared to diagnostic criteria for delirium and also to existing validated scales. The accuracy of the tool was assessed using receiver operating characteristic analysis, and the concurrent and construct validity of the tool was established by comparing the screening tool to validated tools in terms of severity, accuracy at existing cutoff scores, duration of delirious episode and alignment with theoretical constructs. Data analysis indicated that the proposed tool was demonstrated to be a highly accurate and valid screening instrument for delirium in a population of patients in an inpatient medical rehabilitation setting. Because the screening tool is efficient and objective relative to other measures available for delirium screening, it holds the potential to improve the recognition and subsequent treatment of the disorder.