Can we improve delirium prevention and treatment in the emergency department? A systematic review

Lee, Sangil; Chen, Hao; Hibino, Seikei; Miller, Daniel G.; Healy, Heather; Lee, Jacques; Arendts, Glenn; Han, Jin H.; Kennedy, Maura; Carpenter, Christopher R.

doi:10.1111/jgs.17740

Cited by 26 publications

(23 citation statements)

References 84 publications

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“…Furthermore, the figures will further grow over the coming years as the older population continues to increase. Delirium is an under-diagnosed and under-treated syndrome in all settings, reaching a prevalence of up to 38% in the ED [ 4 ]. The prevention, detection and treatment of delirium is a challenge nowadays, due to its multifactorial nature, in addition to the presence of subtypes with different presentations and symptoms, as well as the concurrence of delirium with other patient comorbidities [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Challenges in the Detection of Clinically Useful Biomarkers for the Diagnosis of Delirium in Older People in the Emergency Department—A Case–Control Study

Soler-Sanchis

Martínez-Arnau

Sánchez-Frutos

et al. 2022

Life

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Background: The identification of biomarkers associated with delirium in the emergency department could contribute to the understanding, prediction and diagnosis of this disorder. The present study was carried out to identify biomarkers included in easily and quickly obtained standard blood examinations in older patients with delirium in the emergency department. Methods: A case–control study was carried out in the emergency department of Francesc de Borja Hospital (Gandía, Valencia, Spain). Older adults (≥65 years of age) diagnosed with delirium (n = 128) were included. Cases due to alcohol or substance abuse were excluded. Controls were selected on a randomized basis from the remaining patients (n = 128). All laboratory test parameters included in the routine blood and urine tests of the emergency department were collected. Results: The mean age of the patients was 81.24 ± 7.51 years, and 56.2% were males, while the mean age of the controls was 78.97 ± 7.99 years, and 45.3% were males. Significant differences were found between the cases and controls in relation to the following parameters: urea 43 (32–58) mg/dL versus 50 (37–66) mg/dL, respectively; neutrophils 69.6 (62.05–78.75)% versus 75.5 (65.1–83.2)%; monocytes 8.7 (7–10.4)% versus 7.6 (5.5–9.2)%; platelets 213 (159–266) × 109/L versus 224 (182–289) × 109/L; neutrophil–lymphocyte ratio 3.88 (2.45–7.07) versus 5 (2.75–8.83); platelet–lymphocyte ratio 281.4 (210–360) versus 357.1 (257.8–457.1); and mean platelet volume 10.6 (10–11.5) fl versus 10.4 (9.67–10.9) fl. Although the mean values were above desirable levels in both groups, they were higher for most parameters in the control group. No significant differences were observed in C-reactive protein concentration (9.99 (1.69–51) mg/L versus 12.3 (3.09–65.97) mg/L). Conclusions: The identification of delirium biomarkers poses difficulties due to the urgent nature of the disorders found in older people admitted to the emergency department. Research in this field is needed, since it would allow early identification and treatment of delirium.

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Section: Discussionmentioning

confidence: 99%

“…Delirium in the emergency department (ED) is associated with a longer hospital stay, functional and cognitive impairment, an increased risk of falls and a greater likelihood of institutionalization, ultimately with an increase in patient morbidity and mortality [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges in the Detection of Clinically Useful Biomarkers for the Diagnosis of Delirium in Older People in the Emergency Department—A Case–Control Study

Soler-Sanchis

Martínez-Arnau

Sánchez-Frutos

et al. 2022

Life

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“…In einer neueren Studie wurden die Auswirkungen von Maßnahmen im Rahmen der Notfallversorgung auf die Ausprägung eines Deliriums untersucht [50]. Auch hier wurden Patienten mit hüftgelenknahen Frakturen als hauptgefährdet identifiziert, wobei kaum medikamentöse Interventionen zur Beeinflussung der Auftretenswahrscheinlichkeit des Delirs herausgearbeitet werden konnten.…”

Section: Cme-fortbildungunclassified

“…Ein Ansatz könnte die differenzierte Verwendung von Melatonin sein, wobei dies laut den Autoren weiterer Analysen bedarf. Interessanterweise war die Anlage eines Blasenkatheters in der Notaufnahme mit einem signifikant längeren Delirium assoziiert [50]. Punkte sammeln auf CME.thieme.de…”

Section: Cme-fortbildungunclassified

Alterstraumatologische Akutbehandlung

Wagner¹,

Heykendorf²,

Schumm³

et al. 2022

Notfallmedizin up2date

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“… 9 , 10 However, there is limited research investigating delirium prevention and no research into delirium treatment initiated in the ED. 11 …”

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confidence: 99%

It's time to mobilize: Moving mobility interventions for delirium from inpatient units to the emergency department

Kennedy

2023

JACEP Open

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Delirium occurs in 10%-15% of all older emergency department (ED) patients and accounts for 1.5 million ED visits annually, yet emergency clinicians miss this diagnosis one third of the time. [1][2][3] For this reason, ED-based delirium research has predominantly focused on improving delirium identification. However, delirium identification alone without a concerted effort to improve management is insufficient to ameliorate the detrimental effects of delirium. One third of hospitalized older adults and up to 80% of critically ill patients have delirium. 4,5 Delirium is associated with higher mortality, future cognitive decline, greater institutionalization, longer hospital lengths of stay, and greater costs of care. 5,6 Accordingly, it is critical that we implement evidence-based interventions to decrease incident delirium and delirium duration. Non-pharmacologic delirium prevention programs in inpatient wards, which include early mobility, have been shownto prevent approximately half of incident delirium and may decrease inpatient falls, hospital lengths of stay, and costs of care. 7,8 Delirium prevention bundles in inpatient wards and ICUs, which also address mobility, have been demonstrated to reduce mortality and decrease delirium duration. 9,10 However, there is limited research investigating delirium prevention and no research into delirium treatment initiated in the ED. 11 In this issue of JACEP Open, Jordano et al examined the impact of physical therapy (PT) and/or occupational therapy (OT) on delirium duration among ED patients admitted to the hospital. This was a secondary analysis of the prospective cohort study by Han et al funded by the National Institute on Aging, which enrolled a total of 228 patients, of which 105 had delirium, 47 had subsyndrome delirium, and 76 were not delirious in the ED. 12 This secondary analysis was restricted to 130 patients who received PT/OT during their hospitalization. The authors report that the time spent with PT/OT relative to hospital length of stay, termed "PT/OT intensity," was associated with a significant reduction in delirium duration (adjusted odds ratio [OR] = 0.39; 95% confidence interval [CI]: 0.21, 0.73). However, time to initiation of PT/OT was not associated with delirium duration (adjusted OR = 1.02; 95% CI: 0.82, 1.27). What makes this study particularly noteworthy is the inclusion of patients diagnosed with delirium in the ED-to the best of our knowledge presently, this is the only study to examine the effect of PT/OT as a treatment for delirium in ED patients who were hospitalized.Several key limitations of the Jordano et al study merit scrutiny. The

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Can we improve delirium prevention and treatment in the emergency department? A systematic review

Cited by 26 publications

References 84 publications

Challenges in the Detection of Clinically Useful Biomarkers for the Diagnosis of Delirium in Older People in the Emergency Department—A Case–Control Study

Challenges in the Detection of Clinically Useful Biomarkers for the Diagnosis of Delirium in Older People in the Emergency Department—A Case–Control Study

Alterstraumatologische Akutbehandlung

It's time to mobilize: Moving mobility interventions for delirium from inpatient units to the emergency department

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