The articles by Guenther et al and Gesin et al published in the January edition of the American Journal of Critical Care are important contributions to the discussion of how best to identify delirium in the intensive care unit (ICU).

Gesin et al performed a comprehensive evaluation of a multifaceted education program. Guenther et al reported the first study to identify the false-positive rate of subjective delirium assessments compared to an objective standard. However, both papers fall into the common trap of confusing a disease entity with the results of a diagnostic test.

Delirium is a pathophysiologic process, the mechanisms of which are poorly understood and the manifestations of which are protean, fleeting, and influenced by baseline cognitive state, environment, and method of assessment. As a result, comparisons of diagnostic methods for detecting delirium will inevitably produce different results, and training in a particular diagnostic method will...

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