Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

Abstract

, MBChB, FRCP INTRODUCTION The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards. METHODSA single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient. RESULTSA total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years.The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score. CONCLUSIONThe prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.

Underdiagnosis of delirium in the elderly in acute care hospital settings: lessons not learned

“…Prevalence of delirium detected by CAM in the present study was 28.2%, which is similar to the prevalence of 28.1% reported by a recent study with patients aged 60 years or more treated in an emergency service . It is also in agreement with the literature, which shows a prevalence of delirium ranging from 10% to 30% in elderly individuals admitted through the emergency department .…”

“…Despite the high prevalence of delirium in the sample, the physicians in the present study did not consider this possibility in 64.5% of patients. This translated to low diagnostic sensitivity (35.5%) and accuracy (81.8%), but excellent specificity (100%), a fact that has also been reported in a recent study . Another study carried out with the elderly in an emergency department reported a sensitivity of 45% and a specificity of 97% for the diagnosis of delirium, which is similar to what we observed .…”

Adaptação de teste para rastreio de delirium em idosos admitidos em serviço de urgência

“…A prevalência de delirium neste estudo foi de 25,6%, condizente com a literatura. 5,7,19,20,22,23 Até onde sabemos, o AMT é o primeiro teste adaptado para a população brasileira para avaliação de delirium em unidades de urgência que pode ser aplicado diretamente ao paciente, sem a necessidade de um informante. Além de sua aplicação durar menos de 1 minuto, 18 o fato de o AMT não depender de um informante, que muitas vezes não está disponível na primeira avaliação do idoso, permite uma avaliação rápida do estado cognitivo em serviços de urgência, o que pode reduzir de fato o tempo de diagnóstico de delirium.…”

The Incidence of Recorded Delirium Episodes Before and After Dementia Diagnosis: Differences Between Dementia With Lewy Bodies and Alzheimer's Disease

“…In other words, given that this is a survivor cohort, patients need to survive until a formal dementia diagnosis is established. Another shortcoming relates to the rate of clinical diagnosis of DLB and delirium which is often cited as being under reported in the hospital setting 3,33,34 . Further, some patients might have protracted episodes of delirium 15 , lasting longer than the two weeks used in this analysis to distinguish separate episodes in this analysis.…”