Abnormal Level of Arousal as a Predictor of Delirium and Inattention: An Exploratory Study

Tieges, Zoë; McGrath, Aisling; Hall, Roanna J.; MacLullich, Alasdair M.J.

doi:10.1016/j.jagp.2013.05.003

Cited by 103 publications

(127 citation statements)

References 22 publications

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“…Delirium is also associated with increased mortality [15][16][17][18] and the majority of patients with acute-onset reduced level of arousal meet criteria for delirium [4,5,8,13]. Additionally, some delirium studies exclude patients with severely reduced level of arousal [19]; this restricted spectrum may have led to underestimation of the relationship between delirium diagnosis and mortality.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…The majority of studies did not present sufficient information to allow us to comment on the presence of delirium, but it is established that acuteonset reduced level of arousal, in non-comatose patients, is a highly specific indicator of delirium [4,5,8,13]. Only two [4,34] of the included studies looked for delirium amongst their patients.…”

Section: Interpretation and Implications For Clinical Practice And Fumentioning

confidence: 99%

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57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

2018

Age and Ageing

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Background: Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods: We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results: From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 -83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions: Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.

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Section: Summary Of Findingsmentioning

confidence: 99%

Section: Interpretation and Implications For Clinical Practice And Fumentioning

confidence: 99%

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

2018

Age and Ageing

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“…The clinicians created the gold standard of PD based on actual information in the EHR. Diagnosing PD was in part based on a consciousness assessment tool, the Observational Scale of Level of Arousal (OSLA) [33,34], as the EHR lacked sufficient data to use standardized delirium screening instruments. Hence, there is a risk that the gold standard could be biased.…”

Section: Limitations and Further Workmentioning

confidence: 99%

Using anchors from free text in electronic health records to diagnose postoperative delirium

Mikalsen

Soguero-Ruíz

Jensen

et al. 2017

Computer Methods and Programs in Biomedicine

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Objectives. Postoperative delirium is a common complication after major surgery among the elderly. Despite its potentially serious consequences, the complication often goes undetected and undiagnosed. In order to provide diagnosis support one could potentially exploit the information hidden in free text documents from electronic health records using data-driven clinical decision support tools. However, these tools depend on labeled training data and can be both time consuming and expensive to create. Methods. The recent "Learning with Anchors" framework resolves this problem by transforming key observations (anchors) into labels. This is a promising framework, but it is heavily reliant on clinician's knowledge for specifying good anchor choices in order to perform well. In this paper we propose a novel method for specifying anchors from free text documents, following an exploratory data analysis approach based on clustering and data visualization techniques. We investigate the use of the new framework as a way to detect postoperative delirium. Results. By applying the proposed method to medical data gathered from a Norwegian University Hospital, we increase the area under the precision-recall curve from 0.51 to 0.96 compared to baselines. Conclusions. The proposed approach can be used as a framework for clinical decision support for postoperative delirium.

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“…Recent validation and other delirium screening tool studies are summarized in Table 1[43 ▪ ,[44,[45–[49,[50 ▪ ,[51 ▪ ,[52,[53 ▪ ]. Foremost among these is a systematic review of the CAM [43 ▪ ].…”

Section: Potential Delirium Screening Strategies and Toolsmentioning

confidence: 99%

Delirium diagnosis, screening and management

Lawlor

Bush

2014

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewOur review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care.Recent findingsDelirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation.SummaryAlthough formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting.

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Abnormal Level of Arousal as a Predictor of Delirium and Inattention: An Exploratory Study

Cited by 103 publications

References 22 publications

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

Using anchors from free text in electronic health records to diagnose postoperative delirium

Delirium diagnosis, screening and management

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