Delirium is common among old patients in hospital, especially those who undergo hip surgery. Various instruments have been developed for detecting delirium. One of these, the NEECHAM Confusion Scale, is easy for nurses to administrate but needs to be tested further. The aim of the present study was to assess the validity and predictive value of the NEECHAM Confusion Scale. Methods: The study was conducted in an orthopaedic clinic in Sweden among 149 patients aged >65, who had undergone surgery for a hip fracture. The patients were observed daily regarding DSM-IV criteria for delirium. The NEECHAM Confusion Scale was performed upon admission and prior to discharge. Results: The incidence of DSM-IV related delirium was 24%. Patients who scored below 25p on the NEECHAM scale had a 12 times higher risk of developing DSM-IV related delirium. In relation to delirium, according DSM-IV, the sensitivity upon admission of NEECHAM scale was 0 and the specificity was 75%. On discharge it was 100% and 91% respectively. Conclusions: This study compliments the topics that NEECHAM Confusions Scale discriminates for delirium. It is a valid and reliable screening instrument for predicting delirium. However, there are views on whether its physiological measurements should be excluded or not. The instrument should be used within clinical practice to identify older patients who are at risk of contracting delirium and when considering prevention measures.