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

Abstract

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.

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

“…The incidence of delirium has been reported to range 20-30% in patients hospitalized in general wards (Juliebo et al, 2009;Mariz et al, 2013;McPherson et al, 2013;Sharma et al, 2012;Van Rompaey et al, 2009), 36-44% in elderly post-surgery patients (Juliebo et al, 2009;Robinson et al, 2009), and 32-87% in patients hospitalized in the intensive care unit (ICU) (Ouimet et al, 2007;Vasilevskis et al, 2012;Wells, 2012). Although the incidence of delirium in Korea has been reported as 22% in ICU patients and 10-32% in post-surgery elderly patients (Kang et al, 2011;Kim et al, 2008), an incidence of 26% in ICU patients was reported in a recent large-scale study reported (Moon et al, 2013).…”

Delirium and Length of Hospital Stay among Medical Inpatients in Jos University Teaching Hospital, North-Central Nigeria

“…To our knowledge, this is the first hospital-based study to evaluate the relationship between delirium and length of hospital stay among medical inpatients in Nigeria. [13] and China [14], which all indicated that delirium was an independent risk factor for pronged length of hospital stay. However, there are sparse data on differential effects of delirium on clinical outcomes including length of hospital stay in Nigeria.…”

Delirium: O 7º Parâmetro Vital?

“…Um estudo avaliou a prevalência de delirium numa unidade de cuidados intermédios de um serviço de urgência identificando o mesmo em 20,1% da população. 17 Uma tese de mestrado identificou numa população de doentes seguidos na consulta de suporte intra-hospitalar e consulta externa de um serviço de cuidados paliativos, uma prevalência de 41,2% de delirium 18 Numa unidade de Acidente Vascular Cerebral (AVC) constatou-se num período de cinco anos o diagnóstico de delirium em 10,2% dos doentes admitidos. 19 Num outro estudo realizado numa enfermaria de medicina interna no período de um ano, constatou-se nos últimos 20 dias de internamento a prevalência de 2,5% de delirium nos doentes que morreram.…”