Confusion

Confusion is the inability to maintain a coherent stream of thought or action. Altered level of consciousness is common in confusional states and can be the predecessor of stupor and coma if the underlying cause is not found and reversed. Delirium refers to a confusional state caused by a medical condition. Patients with delirium present a unique challenge in acquiring a history, because the organ system required to report on symptoms, the central nervous system (CNS), is itself dysfunctional. For that reason, clinicians must obtain most of the historical information from caregivers and family members. Nonetheless, the history is crucial to determining the correct diagnosis. Often, delirium coexists with dementia. Demented patients are particularly vulnerable to lapse into confusion, a state termed “beclouded dementia.” Among patients who present to an emergency department with delirium, the diagnosis is overlooked in up to 40-60% of cases.Regardless of cause, delirium confers a worse prognosis with higher hospital readmission rates and 30-day mortality, especially if untreated...