Delirium in internal medicine patients evaluated using the Thai confusion assessment method for ICU

Abstract

Background: Delirium is the condition of an acute confusional state that disturbs both alertness and cognition. The problem is likely to happen with general internal medicine patients admitted in general wards. Objective: To identify delirium cases in the internal medicine In-Patient Department (IPD) by using the Thai Confusion Assessment Method for intensive care unit (CAM-ICU). Materials and Methods: The cross-sectional study was conducted between February and December 2018. The Thai version of the CAM-ICU was used as the evaluation form to detect delirium. The patients admitted to the IPD of internal medicine were freely randomized to be volunteers. Demographic data, systemic illnesses, neurology diseases, and current medications were recorded. Results: Three hundred fifty-six patients, 175 males (49.2%) and 181 females (50.8%), were included in the present study. The mean age was 61.52 years old. The development of acute confusion was significant in patients 50 years old and older (p<0.001). Multivariate analysis indicated the significant effect of substance abuse (p<0.05), chronic kidney disease (p<0.05), cerebrovascular disease (p<0.05), benzodiazepine usage (p<0.05), alcohol abuse (p<0.05), and age 50 years or older (p<0.001). Sixty-nine cases met the Thai CAM-ICU criteria for delirium of CAM-ICU, but the interns did not notice this problem (p<0.001). Conclusion: Chronic kidney disease, cerebrovascular disease, substance abuse, benzodiazepine use, alcohol abuse, and age 50 years or older are the factors associated with delirium in the present study. Hypoactive delirium is underdiagnosed by doctors but revealed by using CAM-ICU. © 2020 Journal of The Medical Association of Thailand.