RT Journal
A1 Radtke FM, Gaudreau J, Spies C
T1 DIagnosing delirium
JF JAMA
JO JAMA
YR 2010
FD November 17
VO 304
IS 19
SP 2124
OP 2127
DO 10.1001/jama.2010.1616
UL http://dx.doi.org/10.1001/jama.2010.1616
AB 
Delirium as a term for acute cerebral dysfunction falls short when perceived as a binary phenomenon with the only options of present or completely absent. This approach will arbitrarily generate a cutoff on a continuous or ordinal range of dysfunction. For either conservative or interventional measures, early detection of delirium—even at predelirium or subsyndromal levels—is of great importance. Similar to pain, delirium presents in degrees better represented on an ordinal scale (eg, 0-10) than represented simply as yes or no. As with pain, evolving delirium should alert physicians to look for underlying possible causes and opens the possibility of treatment before reaching a critical value. With respect to outcomes, the severity as well as the length of delirium symptoms matters.2 Additionally, patients with subsyndromal delirium are at an increased risk of adverse outcomes.3