Delirium: Its historical evolution and current interpretation

Deksnytė, Aušra; Aranauskas, Ramūnas; Budrys, Valmantas; Kasiulevičius, Vytautas; Šapoka, Virginijus

doi:10.1016/j.ejim.2012.06.010

Cited by 14 publications

(7 citation statements)

References 19 publications

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“…Despite progress in the understanding of its clinical presentation, analysis of its clinical epidemiology, presentation and consequence to the overall clinical outcome remains complex [5-11]. In fact, although studies have indicated that delirium is a predictor of a longer hospital stay [5], there is limited work concerning delirium prevalence and physician detection rates in the emergency and/or acute care setting(s); furthermore, published data is predominantly from North America [9,12-14].…”

Section: Backgroundsmentioning

confidence: 99%

Risk and clinical-outcome indicators of delirium in an emergency department intermediate care unit (EDIMCU): an observational prospective study

et al. 2013

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BackgroundIdentification of delirium in emergency departments (ED) is often underestimated; within EDs, studies on delirium assessment and relation with patient outcome in Intermediate Care Units (IMCU) appear missing in European hospital settings. Here we aimed to determine delirium prevalence in an EDIMCU (Hospital de Braga, Braga, Portugal) and assessed routine biochemical parameters that might be delirium indicators.MethodsThe study was prospective and observational. Sedation level was assessed via the Richmond Agitation-Sedation Scale and delirium status by the Confusion Assessment Method for the ICU. Information collected included age and gender, admission type, Charlson Comorbidity Index combined condition score (Charlson score), systemic inflammatory response syndrome criteria (SIRS), biochemical parameters (blood concentration of urea nitrogen, creatinine, hemoglobin, sodium and potassium, arterial blood gases, and other parameters as needed depending on clinical diagnosis) and EDIMCU length of stay (LOS). Statistical analyses were performed as appropriate to determine if baseline features differed between the ‘Delirium’ and ‘No Delirium’ groups. Multivariate logistic regression was performed to assess the effect of delirium on the 1-month outcome.ResultsInclusion and exclusion criteria were met in 283 patients; 238 were evaluated at 1-month for outcome follow-up after EDIMCU discharge (“good” recovery without complications requiring hospitalization or institutionalization; “poor” institutionalization in permanent care-units/assisted-living or death). Delirium was diagnosed in 20.1% patients and was significantly associated with longer EDIMCU LOS. At admission, Delirium patients were significantly older and had significantly higher blood urea, creatinine and osmolarity levels and significantly lower hemoglobin levels, when compared with No Delirium patients. Delirium was an independent predictor of increased EDIMCU LOS (odds ratio 3.65, 95% CI 1.97-6.75) and poor outcome at 1-month after discharge (odds ratio 3.51, CI 1.84-6.70), adjusted for age, gender, admission type, presence of SIRS criteria, Charlson score and osmolarity at admission.ConclusionsIn an EDIMCU setting, delirium was associated with longer LOS and poor outcome at1-month post-discharge. Altogether, findings support the need for delirium screening and management in emergency settings.

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Section: Backgroundsmentioning

confidence: 99%

Risk and clinical-outcome indicators of delirium in an emergency department intermediate care unit (EDIMCU): an observational prospective study

et al. 2013

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“…Little is known about its course over time and which level of agitation should lead to pharmacological treatment [7, 8]. This ambiguities all hamper the development of generalizable clinical guidelines [9].…”

Section: Introductionmentioning

confidence: 99%

Prescribing preferences in rapid tranquillisation: a survey in Belgian psychiatrists and emergency physicians

et al. 2015

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BackgroundThe pharmacotherapeutic management of agitation is a common clinical challenge. Pharmacotherapy is frequently used, the use of published guidelines is not known. The purpose of this study was twofold; to describe the prescribing patterns of psychiatrists and emergency physicians and to evaluate to which extent guidelines are used.MethodsA cross-sectional survey in the Dutch-speaking part of Belgium is carried out in 39 psychiatric hospitals, 11 psychiatric wards of a general hospital and 61 emergency departments. All physicians are asked for demographic information, their prescribing preferences, their use of guidelines and the type of monitoring (effectiveness, safety). For the basic demographic data and prescription preferences descriptive statistics are given. For comparing prescribing preferences of the drug between groups Chi square tests (or in case of low numbers Fisher’s exact test) were performed. Mc Nemar test for binomial proportions for matched-pair data was performed to see if the prescription preferences of the participants differ between secluded and non-secluded patients.Results550 psychiatrist and emergency physicians were invited. The overall response rate was 20% (n = 108). The number 1 preferred medication classes were antipsychotics (59.3%) and benzodiazepines (40.7%). In non-secluded patients, olanzapine (22.2%), lorazepam (21.3%) and clotiapine (19.4%) were most frequently picked as number 1 choice drug. In secluded patients, clotiapine (21.3%), olanzapine (21.3%) and droperidol (14.8%) were the three most frequently chosen number 1 preferred drugs. Between-group comparisons show that emergency physicians prefer benzodiazepines significantly more than psychiatrists do. Zuclopenthixol and olanzapine show a particular profile in both groups of physicians. Polypharmacy is more frequently used in secluded patients. Published guidelines and safety or outcome monitoring are rarely used.ConclusionsOur results show that prescription practice in Flanders (Belgium) in acute agitation shows a complex relationship with published guidelines. Prescription preferences differ accordingly to medical specialty. These findings should be taken into account in future research.

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“…While postoperative delirium has been an increasing concern for spinal surgeons recently, it remains an elusive concept and difficult to diagnose [32]. A diagnosis of delirium is based on the patient's clinical history, behavioral observations, and cognitive assessments [1].…”

Section: Discussionmentioning

confidence: 99%

Delirium after Spinal Surgery: A Pilot Study of Electroencephalography Signals from a Wearable Device

Lee

Kwon²,

Sung³

et al. 2022

Applied Sciences

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Postoperative delirium after spinal surgery in elderly patients has been a recent concern. However, there has not been a study of delirium after spinal surgery based on electroencephalography (EEG) signals from a compact wearable device. We aimed to analyze differences in EEG signals from a wearable device in patients with and without delirium after spinal surgery. Thirty-seven patients who underwent cervical or lumbar decompression and instrumented fusion for degenerative spinal disease were included. EEG waves were collected from a compact wearable device, and percentage changes from baseline to within 1 week and 3 months after surgery were compared between patients with and without delirium. In patients with delirium, the anxiety- and stress-related EEG waves—including the H-beta (19.3%; p = 0.003) and gamma (18.8%; p = 0.006) waves—and the tension index (7.8%; p = 0.011) increased, and the relaxation-related theta waves (−23.2%; p = 0.016) decreased within 1 week after surgery compared to the non-delirium group. These results will contribute to understanding of the EEG patterns of postoperative delirium and can be applied for the early detection and prompt treatment of postoperative delirium after spinal surgery.

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Delirium: Its historical evolution and current interpretation

Cited by 14 publications

References 19 publications

Risk and clinical-outcome indicators of delirium in an emergency department intermediate care unit (EDIMCU): an observational prospective study

Risk and clinical-outcome indicators of delirium in an emergency department intermediate care unit (EDIMCU): an observational prospective study

Prescribing preferences in rapid tranquillisation: a survey in Belgian psychiatrists and emergency physicians

Delirium after Spinal Surgery: A Pilot Study of Electroencephalography Signals from a Wearable Device

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