Hospital discharge data under‐reports delirium occurrence: results from a point prevalence survey of delirium in a major Australian health service

Casey, Penelope; Cross, Wendy; Mart, Melinda Webb St; Baldwin, Cathryn; Riddell, Kath; Dārziņš, Pēteris

doi:10.1111/imj.14066

Cited by 41 publications

(40 citation statements)

References 22 publications

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“…Among the nine point prevalence studies included in the review, the majority were performed in a single country: Australia (Casey et al, ; Hosie et al, ), Denmark (Norbaek & Glipstrup, ), Ireland (Ryan et al, ), Italy (Bellelli et al, ), Scotland (Spiller & Keen, ) and UK (Giraud & Vuylsteke, ). One study (Elliott et al, ) included two countries: Australia and New Zealand; one study (Salluh et al, ) included 11 countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, Spain, USA and Uruguay.…”

Section: Resultsmentioning

confidence: 99%

“…One study (Elliott et al, ) included two countries: Australia and New Zealand; one study (Salluh et al, ) included 11 countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, Spain, USA and Uruguay. All studies focused on inpatient settings: ICU ( n = 3; Elliott et al, ; Giraud & Vuylsteke, ; Salluh et al, ); acute care hospital ( n = 4; Bellelli et al, ; Casey et al, ; Norbaek & Glipstrup, ; Ryan et al, ); and palliative care unit or hospice ( n = 2; Hosie et al, ; Spiller & Keen, ). The sample size for the selected studies ranged from 47–1,867 participants, who were primarily older adults with a reported mean age range of 61–82 years and 42%–63% male.…”

Section: Resultsmentioning

confidence: 99%

“…The Diagnostic and Statistical Manual of Mental Disorder criteria for delirium, DSM‐5 (Hosie et al, ) and DSM‐IV (Norbaek & Glipstrup, ; Ryan et al, ), were commonly used to assess delirium. The next most frequently used tools were as follows: the Confusion Assessment Method (CAM; Ryan et al, ; Spiller & Keen, ); the 4A Test—screening instrument for cognitive impairment and delirium (Bellelli et al, ; Casey et al, ); the Confusion Assessment Method for the ICU (CAM‐ICU; Giraud & Vuylsteke, ; Salluh et al, ); the 3‐Minute Diagnostic Interview for the Confusion Assessment Method (3D‐CAM; Casey et al, ); Brief Confusion Assessment Method (bCAM; Norbaek & Glipstrup, ); Clinical Assessment (Elliott et al, ); Delirium Rating Scale‐Revised‐98 (DRS‐R98), (Ryan et al, ); Delirium‐specific ICD codes (F05.0, F05.1, F05.8, F05.9; Casey et al, ); Intensive Care Delirium Screening Checklist (ICDSC; Elliott et al, ); Spatial Span Forwards (SSF), counting backwards from 20 was used for visually impaired patients (Ryan et al, ); Months Backwards (MB), adapted from the Short Blessed Test for dementia (Ryan et al, ); Nursing Delirium Screening Scale (Nu‐DESC; Hosie et al, ) and other (Elliott et al, ). Two assessment tools were used to identify delirium subtype—Memorial Delirium Assessment Scale (MDAS; Hosie et al, ; Spiller & Keen, ) and Delirium Motor Subtype Scale (DMSS; Bellelli et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…The delirium point prevalence ranged from 9%–34%. The time periods used to measure point prevalence varied—one day ( n = 4; Bellelli et al, ; Casey et al, ; Ryan et al, ; Salluh et al, ); two nonconsecutive days ( n = 2; Hosie et al, ; Norbaek & Glipstrup, ); two consecutive days ( n = 2; Casey et al, ; Spiller & Keen, ); three nonconsecutive days ( n = 1; Elliott et al, ); and seven days ( n = 1; Giraud & Vuylsteke, ).…”

Section: Resultsmentioning

confidence: 99%

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Delirium point prevalence studies in inpatient settings: A systematic review and meta‐analysis

Koirala

Hansen

Hosie

et al. 2020

Journal of Clinical Nursing

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Aims To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. Background Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. Design A systematic review and meta‐analysis. Methods A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random‐effects meta‐analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta‐analysis. Results Nine studies were included in the review, with sample sizes ranging from 47–1867. Delirium point prevalence ranged from 9%–32%. Hypoactive delirium was the most common subtype, ranging from 23%–78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. Conclusions Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies. Relevance to clinical practice Consistent identification of high‐risk patients and treatment settings with elevated risk, accompanied by the implementation of effective preventive and management strategies, are critical to addressing delirium—a frequent and burdensome condition, that adversely affects patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Delirium point prevalence studies in inpatient settings: A systematic review and meta‐analysis

Koirala

Hansen

Hosie

et al. 2020

Journal of Clinical Nursing

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“…The protocol was completed for 559, of whom 245 (43.9%) returned abnormal screening tests (4AT score of ≥1). Delirium was detected in 91 patients (16.3%) . We noted that delirium was found in some patients who had 4AT scores of 1‐3 and also that delirium was not found in some patients who had 4AT scores of 4 or more (refer to Table ).…”

Section: Resultsmentioning

confidence: 69%

Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi‐campus Australian health service

et al. 2019

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Objective To design, test (pilot) and implement a study to estimate the point prevalence of cognitive impairment (CI) and delirium in a multi‐site health service. Methods Clinicians were trained to use the 4 A's Test (4AT) to screen for cognitive impairment and delirium, and the 3‐minute Diagnostic Interview for the Confusion Assessment Method (3D‐CAM) to detect delirium in those with abnormal 4AT results. Outcomes of interest were as follows: (a) rates of cognitive impairment and delirium and (b) feasibility of the approach measured by participation rate, “direct survey activity” time, cost and surveyor preparation. Results The rates of cognitive impairment and delirium were 43.8% (245/559) and 16.3% (91/559), respectively. 90.5% (563/622) of eligible adult patients from 25 acute and subacute wards were seen. “Direct survey activities” averaged 14 minutes (range 2‐45) and cost $11.48 per patient. Training evaluation indicated additional education in the 4AT and 3D‐CAM was needed. Conclusion Health services could use this streamlined, inexpensive method to estimate the point prevalence of cognitive impairment and delirium.

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Circadian Rest–Activity Rhythms, Delirium Risk, and Progression to Dementia

Gao

Gaykova

Zheng

et al. 2023

Annals of Neurology

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Objective Delirium is a complex neurocognitive syndrome suspected to be bidirectionally linked to dementia. Circadian rhythm disturbances likely contribute to dementia pathogenesis, but whether these disturbances are related to delirium risk and progression to all‐cause dementia is unknown. Methods We analyzed continuous actigraphy data from 53,417 middle‐aged or older UK Biobank participants during a median 5 years of follow‐up. Four measures were used to characterize the 24‐hour daily rest–activity rhythms (RARs): normalized amplitude, acrophase representing the peak activity time, interdaily stability, and intradaily variability (IV) for fragmentation of the rhythm. Cox proportional hazards models examined whether RARs predicted incident delirium (n = 551) and progression to dementia (n = 61). Results Suppressed 24‐hour amplitude, lowest (Q1) versus highest (Q4) quartile (hazard ratio [HR]Q1 vs Q4 = 1.94, 95% confidence interval [CI] = 1.53–2.46, p < 0.001), and more fragmented (higher IV: HRQ4 vs Q1 = 1.49, 95% CI = 1.18–1.88, p < 0.001) rhythms predicted higher delirium risk, after adjusting for age, sex, education, cognitive performance, sleep duration/disturbances, and comorbidities. In those free from dementia, each hour of delayed acrophase was associated with delirium risk (HR = 1.13, 95% CI = 1.04–1.23, p = 0.003). Suppressed 24‐hour amplitude was associated with increased risk of progression from delirium to new onset dementia (HR = 1.31, 95% CI = 1.03–1.67, p = 0.03 for each 1‐standard deviation decrease). Interpretation Twenty‐four‐hour daily RAR suppression, fragmentation, and potentially delayed acrophase were associated with delirium risk. Subsequent progression to dementia was more likely in delirium cases with suppressed rhythms. The presence of RAR disturbances before delirium and prior to progression to dementia suggests that these disturbances may predict higher risk and be involved in early disease pathogenesis. ANN NEUROL 2023;93:1145–1157

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Hospital discharge data under‐reports delirium occurrence: results from a point prevalence survey of delirium in a major Australian health service

Cited by 41 publications

References 22 publications

Delirium point prevalence studies in inpatient settings: A systematic review and meta‐analysis

Delirium point prevalence studies in inpatient settings: A systematic review and meta‐analysis

Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi‐campus Australian health service

Circadian Rest–Activity Rhythms, Delirium Risk, and Progression to Dementia

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