New consciousness scale for delirium

A new tool for assessing level of consciousness may improve the diagnosis of delirium. We have translated the Observational Scale of Level of Arousal (OSLA) into Norwegian and will use it in clinical practice and research.

Delirium, or ‘acute confusional state’, occurs frequently in acute somatic disease, especially in elderly patients. The condition is associated with poor prognosis and an increased strain on the patient, their next of kin and the health service. Delirium is characterised by acute changes in level of consciousness, attention and cognition, often accompanied by perceptual disturbances and an altered sleep/wake cycle. The condition tends to have a fluctuating course, should not be attributable to an existing cognitive disorder (e.g., dementia), and should be a direct physiological consequence of another medical condition (1, 2). Delirium often goes undiagnosed if one relies on subjective diagnosis, clinical intuition and doctors’ and nurses’ individual experience. The hypoactive variant in particular, with impaired psychomotor speed, lack of initiative, and somnolence, is often mistaken for depression or dementia. The most commonly used diagnostic aid is the Confusion Assessment Method (CAM). However, in recent years, a number of other tools have been developed for diagnosis and assessment of patients with delirium.