Valérie Boucher1, Marie-Eve Lamontagne2, Alexandra Nadeau3, Pierre-Hugues Carmichael4, Krishan Yadav5, Philippe Voyer6, Mathieu Pelletier7, Émilie Gouin8, Raoul Daoust9, Simon Berthelot10, Michèle Morin11, Stéphane Lemire10, Thien Tuong Minh Vu12, Jacques Lee13, Marcel Émond14. 1. Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada; Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec city, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Laval, Québec, Canada; Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada. 2. Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada. 3. Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada; Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec city, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Laval, Québec, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada. 4. Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada. 5. Faculté de Médecine, Université Laval, Laval, Québec, Canada; Department of Emergency Médicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 6. Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada; Faculté des Sciences Infirmières, Université Laval, Laval, Québec, Canada. 7. Faculté de Médecine, Université Laval, Laval, Québec, Canada; Département d'urgence, Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Québec, Canada. 8. Département d'urgence, Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Québec, Canada. 9. Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Département de médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada. 10. Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Laval, Québec, Canada; Faculté de Médecine, Université Laval, Laval, Québec, Canada. 11. Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada; Le Centre Intégré de Santé et de Services Sociaux, Chaudière-Appalaches, Lévis, Québec, Canada. 12. Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Département de gériatrie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Institut de Gériatrie de l'Université de Montréal, Montréal, Québec, Canada. 13. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Services, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. 14. Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada; Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec city, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Laval, Québec, Canada; Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada.
Abstract
BACKGROUND: It is documented that health professionals from various settings fail to detect > 50% of delirium cases. OBJECTIVE: This study aimed to describe the proportion of unrecognized incident delirium in five emergency departments (EDs). Secondary objectives were to compare the two groups (recognized/unrecognized) and assess the impact of unrecognized delirium at 60 days regarding 1) unplanned consultations and 2) functional and cognitive decline. METHOD: This is a sub-analysis of a multicenter prospective cohort study. Independent patients aged ≥ 65 years who tested negative for delirium on the initial interview with an ED stay ≥ 8 h were enrolled. Patients were assessed twice daily using the Confusion Assessment Method (CAM) and the Delirium Index up to 24 h into hospital admission. Medical records were reviewed to assess whether delirium was recognized or not. RESULTS: The main study reported a positive CAM in 68 patients. Three patients' medical files were incomplete, leaving a sample of 65 patients. Delirium was recognized in 15.4% of our participants. These patients were older (p = 0.03) and female (p = 0.01) but were otherwise similar to those with unrecognized delirium. Delirium Index scores were higher in patients with recognized delirium (p = 0.01) and they experienced a more important functional decline at 60 days (p = 0.02). No association was found between delirium recognition and health care services utilization or decline in cognitive function. CONCLUSIONS: This study confirms reports of high rates of missed or unrecognized delirium (84.6%) in ED patients compared to routine structured screening using the CAM performed by a research assistant. Patients with recognized delirium were older women with a greater severity of symptoms and experienced a more significant functional decline at 60 days.
BACKGROUND: It is documented that health professionals from various settings fail to detect > 50% of delirium cases. OBJECTIVE: This study aimed to describe the proportion of unrecognized incident delirium in five emergency departments (EDs). Secondary objectives were to compare the two groups (recognized/unrecognized) and assess the impact of unrecognized delirium at 60 days regarding 1) unplanned consultations and 2) functional and cognitive decline. METHOD: This is a sub-analysis of a multicenter prospective cohort study. Independent patients aged ≥ 65 years who tested negative for delirium on the initial interview with an ED stay ≥ 8 h were enrolled. Patients were assessed twice daily using the Confusion Assessment Method (CAM) and the Delirium Index up to 24 h into hospital admission. Medical records were reviewed to assess whether delirium was recognized or not. RESULTS: The main study reported a positive CAM in 68 patients. Three patients' medical files were incomplete, leaving a sample of 65 patients. Delirium was recognized in 15.4% of our participants. These patients were older (p = 0.03) and female (p = 0.01) but were otherwise similar to those with unrecognized delirium. Delirium Index scores were higher in patients with recognized delirium (p = 0.01) and they experienced a more important functional decline at 60 days (p = 0.02). No association was found between delirium recognition and health care services utilization or decline in cognitive function. CONCLUSIONS: This study confirms reports of high rates of missed or unrecognized delirium (84.6%) in ED patients compared to routine structured screening using the CAM performed by a research assistant. Patients with recognized delirium were older women with a greater severity of symptoms and experienced a more significant functional decline at 60 days.
Authors: Ryan A Tesh; Haoqi Sun; Jin Jing; Mike Westmeijer; Anudeepthi Neelagiri; Subapriya Rajan; Parimala V Krishnamurthy; Pooja Sikka; Syed A Quadri; Michael J Leone; Luis Paixao; Ezhil Panneerselvam; Christine Eckhardt; Aaron F Struck; Peter W Kaplan; Oluwaseun Akeju; Daniel Jones; Eyal Y Kimchi; M Brandon Westover Journal: Crit Care Explor Date: 2022-01-18
Authors: A Marengoni; G Bellelli; A Zucchelli; R Apuzzo; C Paolillo; V Prestipino; S De Bianchi; G Romanelli; A Padovani Journal: Aging Clin Exp Res Date: 2021-02-09 Impact factor: 3.636