Acute confusion

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Acute confusion Patient assessment and
diagnosis of cause

• Mr Rob Simpson
• ED Consultant UHCW

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Acute confusion

• Definition
• Abreviated mental test (AMT)
• Causes
• interactive
• Patient assessment (a practical approach)
• Interactive
• Summary close

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Acute confusion - definition

• There are several medical definitions of delirium
  (including those in the DSM-IV and ICD-10).
  However, all include some core features.
• The core features are
• Disturbance of consciousness (that is, reduced
  clarity of awareness of the environment, with
  reduced ability to focus, sustain, or shift
  attention)
• Change in cognition (e.g., problem-solving
  impairment or memory impairment) or a perceptual
  disturbance
• Onset of hours to days, and tendency to
  fluctuate.
• Common features also tend to include
• Intrusive abnormalities of awareness and affect,
  such as hallucinations or inappropriate emotional
  states

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Abbreviated mental test (AMT)

• Abbreviated mental test score
• 1. Age ?
• 2. Time? (to nearest hour)
• 3. Address for recall at end of test(this
  should be repeated by the patient to ensure it
  has been heard correctly) "42 West Street
• 4. Year?
• 5. Name of this place?
• 6. Identification of two persons (doctor, nurse
  etc.)?
• 7. Date of birth?
• 8. Year of First World War?
• 9. Name of present Monarch?
• 10. Count backwards 20 to 1 Address recall
  correct?

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• Abreviated mental test score /10
• Should score 7 or more out of 10
• Score of 6 or less suggests delirium or dementia

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About / problems

• Developed by geriatricians in 1972
• Not validated for primary care or screening tool
• Some cultural validity issues
• Sensitivity 70-80
• Specificity 71-90
• (at 7-8 cut-off)

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Causes of acute confusion

• DIBBS pnemonic
• Drugs
• Infection
• Biochemical
• Bladder
• Surroundings
• For each consider common and less common causes

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Approach to the confused patient

• Rapid tranquilisation ?
• Capacity / best interests ?
• Assessment
• History ?
• Examination
• Bloods
• Notes and drug chart
• Other investigations

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Summary Close

• Acute confusion is VERY common
• Need a robust and practiced approach to secure
  the underlying cause (DIBBS)
• Common things are common
• Having diagnosed the cause remove it or treat
  it!