Delirium should be included in guidelines and curriculums

One critical factor in the underdiagnosis and undertreatment of delirium in the United Kingdom is likely to be its unsatisfactory coverage in core guidelines and curriculums.

Delirium is not mentioned in the draft guideline on acutely ill patients in hospital from the National Institute for Health and Clinical Excellence (NICE).¹ However, it occurs in 11-42% of medical inpatients and missing the diagnosis can have serious consequences.²

Delirium is also absent from the Joint Committee of Higher Medical Training curriculums for general internal medicine and acute medicine.^{3 4} “Acute confusional states” are mentioned in the latter, but only in the context of minimising distress. In the curriculum from the Royal Colleges of Physicians the sole reference to delirium is in the section on aggressive/disturbed behaviour,⁵ although only a few patients with delirium display aggression. “Acute confusion” appears in the top 20 presentations and the section on medicine in the elderly but with no mention of delirium.

Care of patients would be greatly facilitated if delirium were covered adequately in core guidelines and curriculums. Consistent use of the term delirium and not its multiple, ill defined synonyms would reduce the terminological chaos and diagnostic imprecision which partly underpin the poor rates of recognition.