Title: Delirium - are we really looking for it?
題目：譫妄：我們完全認識它嗎？
Author 作者: Danya Khoujah
翻譯：陳都 校對：肖鋒

Delirium has long been recognized as a common disorder of the geriatric ED population (seen in up to 20% of patients above the age of 65 years), but how good are we at detecting it?
譫妄長期以來被看作是老年急診患者的常見癥狀（65歲以上的患者中比例高達20%以上）。但是我們在發現這類患者的過程中做的如何呢？

Studies show that the diagnosis of delirium is made in the ED in only 11-46% of patients, which means that more than half go undiagnosed. The problem is, the risk of death at 3 months increases by 11% for every 48 hours of delirium the patient experiences, and so does their length of stay and functional decline. It is mostly missed in patients who have a baseline cognitive dysfunction, such as dementia.
研究顯示在急診診斷譫妄的人群僅占到患者比例的11%-46%，這意味著超過半數的被漏診。問題是患者每次譫妄發作48小時其三個月死亡風險增加11%，他們的住院時間及認知功能下降亦是如此。對于合并基礎認知功能不全的患者如癡呆患者，更容易漏診。

So what can we do about that?
那么，我們應該如何做哪？

Treat delirium as a neurolgical emergency; be vigilant about diagnosing it and treating it. There are a lot of neurocognitive tests that can be used for diagnosis (such as the mini-mental status exam), but they are usually too cumbersome to use in an ED setting. The CAM (Confusion Assessment Method) has been extensively studied and has a sensitivity and specifity of about 95% to diagnose delirium. It includes the acuity of onset, fluctuant course, inattention (the hallmark), disorganized thinking and/or altered level of consciousness.
把譫妄作為神經急癥來處理，對其診斷和治療我們應該保持警惕。有很多的神經認知檢測可用于其診斷（如快速精神狀態測試），但是他們用在急診顯得過于繁瑣。CAM(精神混亂評估法)歷經了廣泛的研究，診斷譫妄具有約95%的靈敏度和特異度。包括發作的劇烈程度，波動過程，注意力不集中（標志），思維紊亂、意識水平的改變。

Bottom Line? Don't forget to screen your elderly patients for delirium and treat them accordingly!
要點：對于老年患者不要忘了做譫妄篩查并采取相應的治療。

References 參考文獻
1. Wilber ST, Han JH. Altered Mental Status in the Elderly. Geriatric Emergency Medicine Principles and Practice. Edited by Kahn JH, Maguaran Jr BG, Olshaker JS. New York: Cambridge University Press; 2014: 102-113
2. Barron EA, Holmes J. Delirium within the emergency Care setting, occurence and detection: a systematic review. EMJ 2013; 30(4) 263-268
3. Wei LA, BA, Fearing MA et al. The Confusion Assessment Method: A Systematic Review of Current Usage J Am Geriatr Soc 56:823–830, 2008