G Bellelli1, A Nobili2, G Annoni3, A Morandi4, C D Djade2, D J Meagher5, A M J Maclullich6, D Davis7, A Mazzone8, M Tettamanti2, P M Mannucci9. 1. Department of Health Sciences, University of Milano Bicocca, Italy; Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy. Electronic address: giuseppe.bellelli@unimib.it. 2. Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy. 3. Department of Health Sciences, University of Milano Bicocca, Italy; Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy. 4. Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy; Geriatric Research Group, Brescia, Italy. 5. Graduate Entry Medical School, University of Limerick, Ireland; Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland; Department of Psychiatry, University Hospital Limerick, Ireland. 6. Edinburgh Delirium Research Group, Geriatric Medicine, Division of Health Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Scotland, United Kingdom. 7. MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom. 8. Department of Health Sciences, University of Milano Bicocca, Italy. 9. Scientific Direction, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy.
Abstract
BACKGROUND: Delirium is a neuropsychiatric disorder, triggered by medical precipitants causes. Study aims were to describe the prevalence and impact on in-hospital mortality of delirium identified through ICD-9 codes as well as evidence of neurocognitive deficits demonstrated in a population of older patients admitted to acute medical wards. METHODS: This was a prospective cohort multicenter study of 2521 older patients enrolled in the "Registro Politerapie SIMI (REPOSI)" during the years 2010 and 2012. The diagnosis of delirium was obtained by ICD-9 codes. Cognitive function was evaluated with the Short Blessed Test (SBT) and single SBT items were used as measures of deficits in attention, orientation and memory. Combination of deficits in SBT items was used as a proxy for delirium. Logistic regression was used to evaluate the association with in-hospital mortality of delirium and combined deficits in SBT items. RESULTS: Delirium was coded in 2.9%, while deficits in attention, orientation, and memory were found in 35.4%, 29.7% and 77.5% of patients. Inattention and either disorientation or memory deficits were found in 14.1%, while combination of the 3 deficits in 19.8%. Delirium, as per ICD-9 codes, was not a predictor of in-hospital mortality. In contrast, objective deficits of inattention, in combination with orientation and memory disorders, were stronger predictors after adjusting for covariates. CONCLUSIONS: The documentation of delirium is poor in medical wards of Italian acute hospitals. Neurocognitive deficits on objective testing (in a pattern suggestive of undiagnosed delirium) should be used to raise awareness of delirium, given their association with in-hospital mortality.
BACKGROUND: Delirium is a neuropsychiatric disorder, triggered by medical precipitants causes. Study aims were to describe the prevalence and impact on in-hospital mortality of delirium identified through ICD-9 codes as well as evidence of neurocognitive deficits demonstrated in a population of older patients admitted to acute medical wards. METHODS: This was a prospective cohort multicenter study of 2521 older patients enrolled in the "Registro Politerapie SIMI (REPOSI)" during the years 2010 and 2012. The diagnosis of delirium was obtained by ICD-9 codes. Cognitive function was evaluated with the Short Blessed Test (SBT) and single SBT items were used as measures of deficits in attention, orientation and memory. Combination of deficits in SBT items was used as a proxy for delirium. Logistic regression was used to evaluate the association with in-hospital mortality of delirium and combined deficits in SBT items. RESULTS: Delirium was coded in 2.9%, while deficits in attention, orientation, and memory were found in 35.4%, 29.7% and 77.5% of patients. Inattention and either disorientation or memory deficits were found in 14.1%, while combination of the 3 deficits in 19.8%. Delirium, as per ICD-9 codes, was not a predictor of in-hospital mortality. In contrast, objective deficits of inattention, in combination with orientation and memory disorders, were stronger predictors after adjusting for covariates. CONCLUSIONS: The documentation of delirium is poor in medical wards of Italian acute hospitals. Neurocognitive deficits on objective testing (in a pattern suggestive of undiagnosed delirium) should be used to raise awareness of delirium, given their association with in-hospital mortality.
Authors: Giuseppe Bellelli; Alessandro Morandi; Marco Trabucchi; Guido Caironi; Daniele Coen; Carlo Fraticelli; Ciro Paolillo; Carolina Prevaldi; Angela Riccardi; Gianfranco Cervellin; Corrado Carabellese; Salvatore Putignano; Stefania Maggi; Antonio Cherubini; Paola Gnerre; Andrea Fontanella; Nicola Latronico; Concezione Tommasino; Antonio Corcione; Giovanni Ricevuti; Nicola Ferrara; Francesco De Filippi; Alberto Ferrari; Mario Guarino; Maria Pia Ruggieri; Pietro Amedeo Modesti; Carlo Locatelli; Patrizia Hrelia; Marco Otto Toscano; Emi Bondi; Antonio Tarasconi; Luca Ansaloni; Francesco Perticone Journal: Intern Emerg Med Date: 2017-07-24 Impact factor: 3.397
Authors: Giuseppe Bellelli; Alessandro Morandi; Simona G Di Santo; Andrea Mazzone; Antonio Cherubini; Enrico Mossello; Mario Bo; Angelo Bianchetti; Renzo Rozzini; Ermellina Zanetti; Massimo Musicco; Alberto Ferrari; Nicola Ferrara; Marco Trabucchi Journal: BMC Med Date: 2016-07-18 Impact factor: 8.775
Authors: Benjamin C Mcloughlin; Amy Miles; Thomas E Webb; Paul Knopp; Clodagh Eyres; Ambra Fabbri; Fiona Humphries; Daniel Davis Journal: Eur Geriatr Med Date: 2020-07-14 Impact factor: 1.710
Authors: Dawn O'Sullivan; Noeleen Brady; Edmund Manning; Emma O'Shea; Síle O'Grady; Niamh O 'Regan; Suzanne Timmons Journal: Age Ageing Date: 2018-01-01 Impact factor: 10.668