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In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity.

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‘Confusion’ is commonly considered normal in older patients, who are most at risk.

Methods We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital.

Screening tests were performed by junior medical trainees.

Studies have shown the importance of early recognition and intervention in reducing the severity and duration of delirium.11 Although studies investigating impact of early intervention on long-term outcomes have been inconsistent, Gonzalez and colleagues found an 11% increase in mortality with every additional 48 h of delirium,12 and Kakuma 13 reported a significant increase in mortality at 6 months in older patients with undetected delirium discharged from the ED, compared to those with delirium who had been appropriately diagnosed.

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Ideally, all patients at high risk of delirium should be assessed regularly using systematic application of sensitive tools.It requires training to ensure accuracy18 and lacks the brevity desired for routine general use.

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