Circle answer
1. Is there any evidence in the chart of acute confusion (e.g., delirium, mental status change, disorientation, hallucinations, agitation, etc.)? Review entire medical record, including progress notes, nursing notes, consult notes, etc. "Yes
No
Uncertain"
2. What is the source of information about the first episode of acute confusion? "Nurse's notes
Physician's progress notes
Other (specify): qquad"
Uncertain
3. Approximate time of onset of first episode of acute confusion? Check nurse's notes, progress notes, orders, laboratories, for earliest time recorded referable to the event. "Date: qquad 1 qquad 1 qquad
Time: qquad qquad am pm"| | Circle answer |
| :---: | :---: |
| 1. Is there any evidence in the chart of acute confusion (e.g., delirium, mental status change, disorientation, hallucinations, agitation, etc.)? Review entire medical record, including progress notes, nursing notes, consult notes, etc. | Yes <br> No <br> Uncertain |
| 2. What is the source of information about the first episode of acute confusion? | Nurse's notes <br> Physician's progress notes <br> Other (specify): $\qquad$ |
| | Uncertain |
| 3. Approximate time of onset of first episode of acute confusion? Check nurse's notes, progress notes, orders, laboratories, for earliest time recorded referable to the event. | Date: $\qquad$ 1 $\qquad$ 1 $\qquad$ <br> Time: $\qquad$ $\qquad$ am pm |
5. What was the total duration (in days) of confusion
(i.e., as determined by all references to confusion
in chart)| 5. What was the total duration (in days) of confusion |
| :--- |
| (i.e., as determined by all references to confusion |
| in chart) |
天数
6. 是否有任何与躁动相关的证据？
伴有谵妄（即亢进性谵妄？
如果回答为 "是"，请说明：
6. Was there any evidence of agitation associated
with the delirium (ie, hyperactive delirium?)
If yes, please describe:| 6. Was there any evidence of agitation associated |
| :--- |
| with the delirium (ie, hyperactive delirium?) |
| If yes, please describe: |
不确定
"5. What was the total duration (in days) of confusion
(i.e., as determined by all references to confusion
in chart)" Days
"6. Was there any evidence of agitation associated
with the delirium (ie, hyperactive delirium?)
If yes, please describe:" Uncertain| | |
| :--- | ---: |
| 5. What was the total duration (in days) of confusion <br> (i.e., as determined by all references to confusion <br> in chart) | Days |
| 6. Was there any evidence of agitation associated <br> with the delirium (ie, hyperactive delirium?) <br> If yes, please describe: | Uncertain |
7. Was there any evidence of reversibility or
improvement of acute confusion during the
hospitalization?
If yes, please describe:| 7. Was there any evidence of reversibility or |
| :--- |
| improvement of acute confusion during the |
| hospitalization? |
| If yes, please describe: |
是
没有
出现谵妄：
Yestain
没有
"7. Was there any evidence of reversibility or
improvement of acute confusion during the
hospitalization?
If yes, please describe:" Yes
No
Delirium Present: Yestain
No| 7. Was there any evidence of reversibility or <br> improvement of acute confusion during the <br> hospitalization? <br> If yes, please describe: | Yes |
| :--- | ---: |
| | No |
| Delirium Present: | Yestain |
| | No |
^(2){ }^{2} Saczynski JS, Kosar CM, Xu G, Puelle MR, Schmitt E, Jones RN, Marcantonio ER, Wong B, Isaza I, Inouye SK.两种方法的故事：识别谵妄的图表法和访谈法。J Am Geriatr Soc. 2014; 62:518-524.PMC3959564