Delirium frequency among advanced cancer patients presenting to an emergency department: A prospective, randomized, observational study

Abstract

Delirium is relatively frequent and is underdiagnosed by physicians in patients with advanced cancer who are visiting the ED. Further research is needed to identify the optimal screening tool for delirium in ED. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2918-2924. © 2016 American Cancer Society.

Cancer patients with delirium in the emergency department: A frequent and distressing problem that calls for better assessment

“…(7) Other studies of elderly patients attending the ED reported an even higher frequency of missing the diagnosis of delirium, ranging from 65-84%. (5,8,9) The lower frequency of missed diagnosis found by Elsayem et al could relate to many factors: the delivery of two lectures to their ED physicians on delirium; priming the ED physician in assessing whether the patient could be approached for study recruitment; and exclusion of patients with dementia and those attending between 6pm and 10am.…”

“…In this current issue of Cancer, Elsayem et al (7) report a cross sectional study to determine the prevalence of delirium in patients with cancer who attended the hospital emergency department. The investigators screened a total of 1832 patients for study entry, and having excluded patients as ineligible, mostly because of nonadvanced cancer (n=694), they had an eligible sample of 624.…”

“…In the study by Elsayem et al, (7) the research assistant rated both the CAM and the MDAS. Interestingly, the authors report that had they used the MDAS cut off score of 7 for a delirium diagnosis instead of the CAM, they would have identified twice as many delirious patients.…”

Reply to Patients with delirium and advanced solid cancer in the emergency department: A challenge for the emergency practitioner, oncologist, and intensivist; and delirium in patients with advanced cancer: Screening to cure or caring to prevent?

“…1 We did not follow patients with delirium longitudinally, and therefore we were unable to determine whether the delirium resolved or persisted after the ED visit, as appropriately suggested by Vincent et al Such a longitudinal follow-up is very important, and should be evaluated in a larger prospec-tive study, preferably after interventions to treat delirium. 1 We did not follow patients with delirium longitudinally, and therefore we were unable to determine whether the delirium resolved or persisted after the ED visit, as appropriately suggested by Vincent et al Such a longitudinal follow-up is very important, and should be evaluated in a larger prospec-tive study, preferably after interventions to treat delirium.…”

“…1 Vincent et al presented a thoughtful discussion regarding the management of delirium in patients with advanced cancer in various settings, including the emergency department (ED) and the intensive care unit (ICU), and the challenges faced by ED physicians, oncologists, and intensivists. 1 Vincent et al presented a thoughtful discussion regarding the management of delirium in patients with advanced cancer in various settings, including the emergency department (ED) and the intensive care unit (ICU), and the challenges faced by ED physicians, oncologists, and intensivists.…”