Delirium Risk Prediction, Healthcare Use and Mortality of Elderly Adults in the Emergency Department

Abstract

Background/Objectives Delirium is common and under-diagnosed in elderly Emergency Department (ED) patients. The primary aim of this study is to create a risk prediction rule for ED delirium. The secondary aim is to compare the mortality rates and resource utilization of delirious versus non-delirious elderly ED patients. Design Prospective observational study. Setting An urban tertiary care emergency department. Participants 700 patients 65 years of age or older and presenting for ED care. Measurements A trained research assistant performed a structured mental status assessment and attention tests, after which delirium was determined using the Confusion Assessment Method. We collected data on patient demographics, comorbidities, medications and ED course, hospital and Intensive Care Unit (ICU) admission, length of stay, hospital charges, and 30-day re-hospitalization and mortality. Results Nine percent of elderly study participants were delirious. Using logistic regression, we created a delirium prediction rule consisting of older age, prior stroke or transient ischemic attack, dementia, suspected infection and acute intracranial hemorrhage with good predictive accuracy (AUC=0.77). Among admitted patients, those with ED delirium had longer median lengths of stay (4 versus 2 days), and were more likely to require ICU admission (13% versus 6%) and to be discharged to a new long-term care facility (37% versus 9%). Among all patients, ED delirium was associated with higher 30-day mortality (6% vs. 1%) and 30-day readmissions (27% vs. 13%). Conclusion Our risk prediction rule may help identify a group of high risk ED patients that should undergo screening for delirium, but requires external validation. Identification of delirium in the ED may enable physicians to implement strategies to decrease delirium duration and avoid inappropriate discharge of acutely delirious patients, thereby improving patient outcomes.

The prevalence, risk factors and short-term outcomes of delirium in Thai elderly emergency department patients

“…That study also found that the inability to perform activities of daily living (ADLs) was a risk factor for delirium; however, our ED did not routinely perform ADL screening. Prior studies have found that ED-diagnosed infections and ED-diagnosed intracranial haemorrhage22 increased the risk of delirium; in our study, ED delirium was only associated with an ED diagnosis of metabolic derangement. Francis et al 23 found that an abnormal sodium level and azotemia were risk factors for delirium, whereas Praditsuwan et al 12 found only pre-renal azotemia was associated with delirium.…”

Delirium in critically ill patients: risk factors modifiable by nurses

“…With regard to the total leukocyte count, Ansaloni et al (2010), De Castro et al (2014 and Kennedy et al (2014) concluded that the number of white cells is higher in patients with delirium (9.6 ± 4.3 vs. 8.3 ± 3.4), which corroborates the results obtained in this study.…”

Comparison of functional outcomes in elderly who have sustained a minor trauma with or without head injury: a prospective multicenter cohort study

“…In addition, it has been shown that a short visit to the ED has repercussions on the cognitive status (recognised as delirium) of elderly patients. [22][23][24][25][26] Another hypothesis is that the presence of a potential overestimation of their function by the patients who had follow-up by phone (80%) rather than face-toface follow-up. However, this bias would be a nondifferential bias, so it would not advantage one group more than the other regarding the outcomes.…”