Development of a checklist for systematic screening of precipitating factors in older patients admitted to hospital with delirium.

Objectives: Causes of delirium are often multiple in older people and a significant number of them are missed at the initial assessment. We wanted to develop a checklist to help clinicians to systematically screen for the most frequent and important causes of delirium in this population.

Methods: Three investigators, based on previous studies, drafted three possible checklist base models, comprising 18-29 items. A panel of 12 experts voted to choose one of the models, and then followed a modified Delphi consensus method to review each item and further develop the checklist. The consensus checklist was then tested in a small group of patients. The target population was older patients with delirium arriving to the emergency department or to a medical hospital ward.

Results: The longest of the three drafts was unanimously chosen by the panel. After three rounds, a consensus was reached and a final checklist agreed. It is composed by 27 items organized in five groups of causes: infections, hydro-electrolytic disturbances, drugs, acute neurological conditions, and other acute diseases. A pilot study conducted by 15 physicians in 21 consecutive patients showed that the checklist was easy to complete, quick (mean 4 min) and most clinicians, though it helped them through the initial diagnostic work.

Conclusions: We have developed and pilot tested a checklist for screening for acute precipitants of delirium in older patients, aimed to facilitate early recognition and treatment of the multiple causes that often coexists in this population.