[Recognising postoperative delirium in the elderly]

Abstract

Objective: To determine the degree of agreement between delirium experts on the diagnosis of delirium based on exactly the same information, and to assess the sensitivity of delirium screening methods used by clinical nurses.

Design: Prospective observational longitudinal study.

Method: Older patients (≥ 60 years) who underwent major surgery were included. During the first three days after surgery they had a standardised cognitive screening test which was recorded on video. Two delirium experts independently evaluated these videos and the information from the patient records. They classified the patients as having 'no delirium', 'possible delirium' or 'delirium'. If there was disagreement, a third expert was consulted. The final classification, based on consensus of two or three delirium experts, was compared with the result of the delirium screening carried out by the clinical nurses.

Results: A total of 167 patients were included and 424 postoperative classifications were obtained. The agreement between the experts was 0.61 (95% confidence interval (CI): 0.53-0.68), based on Cohen's kappa. In 89 (21.0%) of the postoperative classifications there was no agreement between the experts and a third expert was consulted. The nurses using the delirium screening tools recognised 32% of the cases that had been classified as delirium by the experts.

Conclusion: There was considerable disagreement between the classifications of individual delirium experts, based on exactly the same information, indicating the difficulty of the diagnosis. Furthermore, the sensitivity of the delirium screening tools used by the clinical nurses was poor. Further research should focus on the development of objective methods for recognising delirium.