OBJECTIVES: The consequences of delirium in the emergency department (ED) remain unclear. This study sought to determine if delirium in the ED was an independent predictor of prolonged hospital length of stay (LOS). METHODS: This prospective cohort study was conducted at a tertiary care, academic ED from May 2007 to August 2008. The study included English-speaking patients aged 65 and older who were in the ED for less than 12 hours at enrollment. Patients were excluded if they refused consent, were previously enrolled, were unable to follow simple commands at baseline, were comatose, or did not have a delirium assessment performed by the research staff. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to determine delirium status. Patients who were discharged directly from the ED were considered to have a hospital LOS of 0 days. To determine if delirium in the ED was independently associated with time to discharge, Cox proportional hazard regression was performed adjusted for age, comorbidity burden, severity of illness, dementia, functional impairment, nursing home residence, and surgical procedure. A sensitivity analysis, which included admitted patients only, was also performed. RESULTS: A total of 628 patients met enrollment criteria. The median age was 75 years (interquartile range [IQR] = 69-81), 365 (58%) patients were female, 111 (18%) were nonwhite, 351 (56%) were admitted to the hospital, and 108 (17%) were delirious in the ED. Median LOS was 2 days (IQR = 0-5.5) for delirious ED patients and 1 day (IQR = 0-3) for nondelirious ED patients (p < 0.001). The hazard ratio (HR) of delirium for time to discharge was 0.71 (95% confidence interval [CI] = 0.57 to 0.89) after adjusting for confounders, and indicated that ED patients with delirium were more likely to have prolonged hospital LOS compared with those without delirium. For the sensitivity analysis, which included only hospitalized patients, the adjusted HR was 0.76 (95% CI = 0.58 to 0.99). CONCLUSIONS: Delirium in older ED patients has negative consequences and is an independent predictor of prolonged hospitalizations.
OBJECTIVES: The consequences of delirium in the emergency department (ED) remain unclear. This study sought to determine if delirium in the ED was an independent predictor of prolonged hospital length of stay (LOS). METHODS: This prospective cohort study was conducted at a tertiary care, academic ED from May 2007 to August 2008. The study included English-speaking patients aged 65 and older who were in the ED for less than 12 hours at enrollment. Patients were excluded if they refused consent, were previously enrolled, were unable to follow simple commands at baseline, were comatose, or did not have a delirium assessment performed by the research staff. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to determine delirium status. Patients who were discharged directly from the ED were considered to have a hospital LOS of 0 days. To determine if delirium in the ED was independently associated with time to discharge, Cox proportional hazard regression was performed adjusted for age, comorbidity burden, severity of illness, dementia, functional impairment, nursing home residence, and surgical procedure. A sensitivity analysis, which included admitted patients only, was also performed. RESULTS: A total of 628 patients met enrollment criteria. The median age was 75 years (interquartile range [IQR] = 69-81), 365 (58%) patients were female, 111 (18%) were nonwhite, 351 (56%) were admitted to the hospital, and 108 (17%) were delirious in the ED. Median LOS was 2 days (IQR = 0-5.5) for delirious ED patients and 1 day (IQR = 0-3) for nondelirious ED patients (p < 0.001). The hazard ratio (HR) of delirium for time to discharge was 0.71 (95% confidence interval [CI] = 0.57 to 0.89) after adjusting for confounders, and indicated that ED patients with delirium were more likely to have prolonged hospital LOS compared with those without delirium. For the sensitivity analysis, which included only hospitalized patients, the adjusted HR was 0.76 (95% CI = 0.58 to 0.99). CONCLUSIONS:Delirium in older ED patients has negative consequences and is an independent predictor of prolonged hospitalizations.
Authors: Y Gustafson; D Berggren; B Brännström; G Bucht; A Norberg; L I Hansson; B Winblad Journal: J Am Geriatr Soc Date: 1988-06 Impact factor: 5.562
Authors: Martin G Cole; Jane McCusker; François Bellavance; François J Primeau; Robert F Bailey; Michael J Bonnycastle; Johanne Laplante Journal: CMAJ Date: 2002-10-01 Impact factor: 8.262
Authors: E Wesley Ely; Ayumi Shintani; Brenda Truman; Theodore Speroff; Sharon M Gordon; Frank E Harrell; Sharon K Inouye; Gordon R Bernard; Robert S Dittus Journal: JAMA Date: 2004-04-14 Impact factor: 56.272
Authors: Eric B Milbrandt; Stephen Deppen; Patricia L Harrison; Ayumi K Shintani; Theodore Speroff; Renée A Stiles; Brenda Truman; Gordon R Bernard; Robert S Dittus; E Wesley Ely Journal: Crit Care Med Date: 2004-04 Impact factor: 7.598
Authors: Jin H Han; Eduard E Vasilevskis; Rameela Chandrasekhar; Xulei Liu; John F Schnelle; Robert S Dittus; E Wesley Ely Journal: J Am Geriatr Soc Date: 2017-03-06 Impact factor: 5.562
Authors: K J Neufeld; J S Leoutsakos; F E Sieber; D Joshi; B L Wanamaker; J Rios-Robles; D M Needham Journal: Br J Anaesth Date: 2013-05-08 Impact factor: 9.166
Authors: Jin H Han; Amanda Wilson; Amy J Graves; Ayumi Shintani; John F Schnelle; Robert S Dittus; James S Powers; John Vernon; Alan B Storrow; E Wesley Ely Journal: Acad Emerg Med Date: 2014-02 Impact factor: 3.451
Authors: Andrea M Yevchak; Jin Ho Han; Kelly Doherty; Elizabeth G Archambault; Brittany Kelly; Rameela Chandrasekhar; E Wesley Ely; James L Rudolph Journal: J Am Med Dir Assoc Date: 2015-03-03 Impact factor: 4.669
Authors: Wolfgang Hasemann; Florian F Grossmann; Rahel Stadler; Roland Bingisser; Dieter Breil; Martina Hafner; Reto W Kressig; Christian H Nickel Journal: Intern Emerg Med Date: 2017-12-30 Impact factor: 3.397
Authors: Annachiara Marra; James C Jackson; E Wesley Ely; Amy J Graves; John F Schnelle; Robert S Dittus; Amanda Wilson; Jin H Han Journal: J Hosp Med Date: 2018-03-26 Impact factor: 2.960
Authors: Jin H Han; Nathan E Brummel; Rameela Chandrasekhar; Jo Ellen Wilson; Xulei Liu; Eduard E Vasilevskis; Timothy D Girard; Maria E Carlo; Robert S Dittus; John F Schnelle; E Wesley Ely Journal: Am J Geriatr Psychiatry Date: 2016-07-04 Impact factor: 4.105
Authors: Tony Rosen; Scott Connors; Sunday Clark; Alexis Halpern; Michael E Stern; Jennifer DeWald; Mark S Lachs; Neal Flomenbaum Journal: Adv Emerg Nurs J Date: 2015 Jul-Sep
Authors: Jin H Han; Amanda Wilson; Eduard E Vasilevskis; Ayumi Shintani; John F Schnelle; Robert S Dittus; Amy J Graves; Alan B Storrow; John Shuster; E Wesley Ely Journal: Ann Emerg Med Date: 2013-07-31 Impact factor: 5.721