Frequency of Delirium in a Neurological Emergency Room

Abstract

The authors present a cross-sectional survey designed to evaluate the presence of delirium in patients with neurological emergencies. Two hundred and two patients were included in the study: 14.9% of subjects had delirium; 62.4% had no arousal disturbances; and 22.7% presented a coma or stupor state. Findings revealed that the presence of a cerebral infection, the presence of multiple etiologies, and the location of lesions in the frontal and temporal lobes were all associated with delirium. Results substantiate that delirium is a frequent occurrence in neurological patients and that the presence of multiple etiologies must be investigated in each patient.

Delirium within the emergency care setting, occurrence and detection: a systematic review

“…Eleven studies were from general hospital EDs, one was from a private hospital ED42 and one was from a neurological ED 43…”

“…Twelve studies were carried out in older populations, with six assessing people aged 65 and over,32–36 43 two assessing people aged 66 over,40 44 and four assessing people aged 70 and over 37–39 44. One study sampled all adult patients 43…”

“…Four of the studies used the non-ED validated Confusion assessment method for the intensive care unit (CAM-ICU) 34–36 42. One used the Delirium Rating Scale,43 and the remainder used the CAM. Although Monette et al is widely referenced as an ED validation of the CAM,11 there are significant issues with this study.…”

“…A systematic review by Wong et al reported that the positive likelihood ratio for the CAM was significantly higher when it was administered by physicians than nurses 10. Only research by Elie et al 32 and Ramirez-Bermudez et al 43 was performed by physicians, and the remainder performed by either a research nurse or research assistant. Interestingly, the physicians were not ED trained.…”

“…As mentioned above, two studies assessed patients within 6 h,43 44 three assessed within 12 h of admission34–36 and the remaining had no time from admission stated. Ideally to assess the prevalence of delirium in the ED, assessment should be undertaken at presentation.…”