Thread by @WesElyMD

1/ 🎥🧵 How do we test someone for #delirium in #COVID19 or any ICU? When someone won’t engage it can be a huge red-flag for “quiet” delirium, which predicts 3X ⬆️ #DEATH by 6 mo & acquired #dementia. Watch this movie of me testing pt #1 for delirium.

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2/ What does this mean? He starts out OK but then can’t follow my command to squeeze only on the letter A. Instead, he squeezes when I say the word “squeeze” & doesn’t relax his grip or vary it on different letters. This is inattention & a cardinal feature of #Delirium.

3/ 🎥 Contrast Pt 1 with this Pt 2 video of me doing the same test. This person had delirium on earlier days & is now improving. He gets 8/10 correct responses, which means he’s attentive and not delirious any more. This day he walked & talked for the 1st time!

#Recovery #nurse

4/ Here’s a CIBS team member testing another pt (pic w perm). Delirium is not about hallucinations & delusions. Inability to pay attention is the cardinal feature. Pt #1 couldn’t follow my simple command because he was secretly septic & inattention was his 🧠 burglar alarm!

5/ For this test, we recite a letter string (eg, CASABLANCA) & ask the pt to squeeze only on “A” & not on other letters. 8 of 10 correct responses is “attention.” We validated the CAM-ICU in JAMA 2001. It’s now translated in >35 languages & used 🌎 over.

bit.ly/3zssMPR

6/fin
Drowsiness…we just published a meta-analysis of 21 studies (N>50,000 pts) showing reduced arousal had a 6X ⬆️ hospital death rate. This can be the canary in the coal mine for #delirium, which we miss to our pts’ peril 😖!

bit.ly/3431vVC

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It may seem hard to believe that such a simple test can predict such important clinical outcomes($ cost, LOS, death, dementia), yet it’s been shown consistently over & over in trials. For non-ICU pts, the 4AT by @A_MacLullich a fabulous bedside clinical tool for #Delirium.