23 Aug Delirium Prediction Rule: the AWOL Tool
MedicalResearch.com Interview with:
Vanja Douglas, MD
Sara & Evan Williams Foundation
Endowed Neurohospitalist Chair
Assistant Professor of Clinical Neurology
UCSF Department of Neurology
Neurology Clerkship Director
Editor in Chief, The Neurohospitalist
MedicalResearch.com: What are the main findings of the study?
Answer: The study found that a simple 2-minute assessment performed at the time of hospital admission can accurately predict an adult medical inpatient’s risk of developing delirium during that hospitalization.
MedicalResearch.com: Were any of the findings unexpected?
Answer: We hypothesized that a simple delirium prediction rule would include a measure of underlying cognitive dysfunction, old age, and illness severity. We also hypothesized that the prediction rule might include other risk factors such as visual and hearing dysfunction, immobility, or dehydration but that was not borne out in our cohort.
MedicalResearch.com: What should clinicians and patients take away from your report?
Answer: Because it can be performed by nurses in roughly 2 minutes, the AWOL tool may be a practical way to systematically risk-stratify elderly medical patients upon admission to the hospital and allow providers to triage those patients for whom delirium prevention strategies should be applied. However, in our study the AWOL tool did not perform as well in the validation cohort as it did in the derivation cohort, and therefore any implementation of the tool in clinical practice should be undertaken with the understanding that its performance should be locally validated.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Answer: I would like to see further research validating the AWOL tool in other hospitals as well as research that attempts to refine the AWOL tool or develop even more effective yet equally simple delirium risk-stratification models. Another avenue for research taking advantage of this tool would be in using it to identify high-risk patients who might be eligible to participate in the investigation of novel delirium prevention strategies and/or therapies.
The AWOL tool: Derivation and validation of a delirium prediction ruleDouglas, V. C., Hessler, C. S., Dhaliwal, G., Betjemann, J. P., Fukuda, K. A., Alameddine, L. R., Lucatorto, R., Johnston, S. C. and Josephson, S. A. (2013), The AWOL tool: Derivation and validation of a delirium prediction rule. J. Hosp. Med.. doi: 10.1002/jhm.2062