scholarly journals P047: Frailty assessment to help predict patients at risk of ED-induced delirium

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S94-S94
Author(s):  
M. Giroux ◽  
V. Boucher ◽  
M. Émond ◽  
M. Sirois ◽  
R. Daoust ◽  
...  
Keyword(s):  
At Risk ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Impact Measurement ◽  
Clinical Frailty Scale ◽  
Patients At Risk ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Introduction: Delirium is a frequent complication among seniors in the emergency department (ED). This condition is often underdiagnosed by ED professionals even though it is associated with functional & cognitive decline, longer hospital length of stay, institutionalization and death. Frailty is increasingly recognized as an independent predictor of adverse events in seniors and screening for frailty in EDs has recently been recommended. The aim of this study was to assess if screening seniors for frailty in EDs could help identify those at risk of ED-induced delirium. Methods: This study is part of the Incidence and Impact measurement of Delirium Induced by ED-Stay study, an ongoing multicenter prospective cohort study in 5 Quebec EDs. Patients were recruited after 8 hours in the ED exposure & followed up to 24h after ward admission. Frailty was assessed at ED admission using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) which classified seniors from robust (1/7) to severely frail (7/7). Seniors with CSHA-CFS ≥ 5/7 were considered frail. Delirium was assessed using the Confusion assessment method and Delirium Index. Results: Of the 380 patients recruited, mean age was 76.5 (±8.9). Male were 50%. Mean stay in the ED was 1.4 day (±0.82). Preliminary data show an incidence of ED-induced delirium of 8.4%. Average frailty score at baseline was 3.5/7. 72 patients were considered frail, while 289 were considered robust. Among the frail seniors, there were 48.4% (30-66%) patients with ED-induced delirium vs 17.9% (13.7-22.0] in the non-frail ones (p<0.0001). Conclusion: Increased frailty appears to be associated with increased ED-induced delirium. Screening for frailty at emergency triage could help ED professionals identify seniors at higher risk of ED-induced delirium. Further studies are required to confirm the importance of the association between frailty and ED-induced delirium

scholarly journals Do we know if our Patients are Delirious?

2008 ◽  
Vol 9 (3) ◽  
pp. 269-269
Author(s):  
Callum Kaye
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Critically Ill Patient ◽  
Confusion Assessment ◽  
Surgical Icu ◽  
Symptoms And Signs

Delirium in the intensive care unit (ICU) setting is a significant cause of morbidity, mortality and increases ICU, as well as hospital length of stay1,2. Furthermore, with so many of the risk factors being present in the critically ill patient in the ICU environment, it's not surprising that other studies have found that up to 80% of patients will be delirious at some point during admission3,4. We performed a small study in a Toronto Medical-Surgical ICU using the Confusion Assessment Method for the ICU (CAM-ICU)5 to determine the prevalence of delirium in this unit. We concurrently reviewed medical and nursing notes to identify documentation of symptoms and signs that could indicate possible delirium during routine clinical assessment of the patient.

scholarly journals LO022: Incidence and impact measurement of delirium induced by ED stay - INDEED

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S37-S38
Author(s):  
M. Émond ◽  
P. Voyer ◽  
R. Daoust ◽  
M. Pelletier ◽  
E. Gouin ◽  
...  
Keyword(s):  
Phase 1 ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Cognitive Status ◽  
Study Phase ◽  
Inclusion Criteria ◽  
Impact Measurement ◽  
Ed Overcrowding ◽  
The Mean

Introduction: Delirium is a dreadful complication in seniors’ acute care. Many studies are available on the incidence of delirium, however ED-induced delirium is far less studied. We aim to evaluate the incidence and impact of ED-induced delirium among older non-delirious admitted ED patients who have prolonged ED stays (≥ 8 hours). Methods: This prospective INDEED study phase 1 included patients recruited from 4 Canadian EDs. Inclusion criteria: 1) Patients aged 65 and over; 2) ED stay ≥ 8 hours; 3) Patient is admitted to the hospital; 4) Patient is non-delirious upon arrival and at the end of the first 8 hours; 5) Independent or semi-independent patient. Eligible patients were assessed by a research assistant after an 8 hour exposition to the ED and evaluated twice a day up to 24h after ward admission. Patients’ functional and cognitive status were assessed using validated OARS and TICS-m tools. The Confusion Assessment Method was used to detect incident delirium. Hospital length of stays (LOS) were obtained. Univariate and multivariate analyses were conducted to evaluate outcomes. Results: Of the 380 patients prospectively followed, mean age was 76.5 (± 8.9), male represent 50% and 16.5% very old seniors (> 85 y.o.). The overall incidence of ED-induced delirium was 8.4%. Distribution by the 4 sites was: 10%, 13.8%, 5.5% & 13.4%. The mean ED LOS varied from 29 to 48 hours. The mean hospital LOS was increase by 6.1 days in the delirious patients compared to non-delirious patient (p<0.05). Increase mean hospital LOS distribution by site was by: 6.9, 8.5, 4.3 and 5.2 days for the ED-induced delirium patients. Conclusion: ED-induced delirium was recorded in nearly one senior out of ten after a minimal 8 hour exposure in the ED environment. An episode of delirium increases hospital LOS by about a week and therefore could contribute to ED overcrowding.

scholarly journals MP11: Underreport of incident delirium in elderly patients treated in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S44-S44 ◽  
Author(s):  
M. Emond ◽  
A. Nadeau ◽  
V. Boucher ◽  
P. Voyer ◽  
M. Pelletier ◽  
...  
Keyword(s):  
Health Professionals ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Cognitive Status ◽  
Observer Agreement ◽  
Hospital Length Of Stay ◽  
Physiological Status ◽  
Clinical Settings ◽  
Medical File

Introduction: It is documented that physicians and nurses fail to detect delirium in more than half of cases from various clinical settings, which could have serious consequences for seniors and for our health care system. The present study aimed to describe the rate of documented incident delirium in 5 Canadian Emergency departments (ED) by health professionals (HP). Methods: This study is part of the multicenter prospective cohort INDEED study. Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Delirium status was assessed twice daily using the Confusion Assessment Method (CAM) by trained research assistants (RA). HP reviewed patient charts to assess detection of delirium. HP had no specific routine detection of delirious ED patients. Inter-observer agreement was realized among RA. Comparison of detection between RA and HP was realized with univariate analyses. Results: Among the 652 included patients, 66 developed a delirium as evaluated with the CAM by the RA. Among those 66 patients, only 10 deliriums (15.2%) were documented in the patients medical file by the HP. 54 (81.8%) patients with a CAM positive for delirium by the RA were not recorded by the HP, 2 had incomplete charts. The delirium index was significantly higher in the HP reported group compared to the HP not reported, respectively 7.1 and 4.5 (p<0.05). Other predictive delirium variables, such as cognitive status, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between groups. Conclusion: It seems that health professionals missed 81.8% of the potential delirious ED patients in comparison to routine structured screening of delirium. HP could identify patients with a greater severity of symptoms. Our study points out the need to better identify elders at risk to develop delirium and the need for fast and reliable tools to improve the screening of this disorder.

Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey

2014 ◽  
Vol 26 (12) ◽  
pp. 2093-2102 ◽  
Author(s):  
G. Bellelli ◽  
A. Morandi ◽  
E. Zanetti ◽  
M. Bozzini ◽  
E. Lucchi ◽  
...  
Keyword(s):  
At Risk ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Tools ◽  
Health Providers ◽  
Survey Period ◽  
Italian Survey ◽  
Multicenter Survey ◽  
Patients At Risk ◽  
Case Vignettes

ABSTRACTBackground:There are no studies that have identified the ability to recognize and manage delirium among Italian health providers caring for patients at risk. Therefore, the Italian Association of Psychogeriatrics (AIP) conducted a multicenter survey among doctors, nurses, psychologists and physiotherapists to assess their competence regarding the theme of delirium and its management in the everyday clinical practice.Methods:The survey period was 1st June 2013 to 30th November 2013. The invitation to participate was sent via email, with publication on the AIP website. The survey included 14 questions and two case vignettes.Results:A total of 648/1,500 responses were collected. Most responders were doctors (n= 322/800), followed by nurses (n= 225/500), psychologists (n= 51/100), and physiotherapists (n= 30/100). Generally, doctors and psychologists correctly defined delirium, while nurses and physiotherapists did not. The most frequently used diagnostic tools were the Confusion Assessment Method (CAM) and the Diagnostic and Statistical Manual of Mental Disorders-IV. Delirium intensity was rarely assessed. Hypoactive delirium was generally managed with non-pharmacological approaches, while hyperactive delirium with a combination of non-pharmacological and pharmacological approaches. However, possible causes of delirium were under-assessed by half of doctors and by the majority of other professionals. Nurses, psychologists and physiotherapists did not answer the case vignettes, while doctors identified the correct answer in most cases.Conclusions:This is the first Italian survey among health providers caring for patients at risk of delirium. This is also the first survey including doctors, nurses, psychologists and physiotherapists. The results emphasize the importance of training to improve knowledge of this relevant unmet medical need.

Delirium in the Hospitalized Patient: A Primer for the Pharmacist Clinician

2007 ◽  
Vol 20 (5) ◽  
pp. 368-372 ◽  
Author(s):  
Brad Laible ◽  
Thomas Johnson
Keyword(s):  
Intensive Care Unit ◽  
Negative Impact ◽  
Treatment Options ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Delirium Assessment ◽  
Confusion Assessment ◽  
Pharmacologic Agents

As appreciation grows for the negative impact delirium has on the clinical outcome of hospitalized patients, pharmacists are becoming more involved in the identification and treatment of this common problem. Delirium has been shown to have a significant impact on such factors as morbidity, mortality, and hospital length of stay. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) provides a simple assessment method for delirium that can be utilized by nonpsychiatrist personnel. While nonpharmacologic strategies are generally recommended to prevent and treat delirium, pharmacologic agents have also been investigated. This article will review causes of delirium, assessment with the CAM-ICU, and treatment options available to the pharmacist clinician.

scholarly journals Period-Prevalence and Risk Factors for Delirium in a Tertiary Referral ICU: A prospective cohort study

2021 ◽  
Vol 20 (3) ◽  
pp. 168-173
Author(s):  
FE Martinez ◽  
◽  
VW Ho ◽  
G Brogan ◽  
C Pickering ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Length Of Stay ◽  
Positive Association ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Treatment Data

Background: Delirium is common in intensive care and leads to increases in morbidity, mortality, Intensive Care Unit (ICU) length of stay, and hospital length of stay. Certain risk factors predict the appearance of delirium. Study Objectives: To determine the rates of delirium, the rate of risk factors, and their relationship to the occurrence of delirium in an adult ICU. Methods: Single-centre, prospective, observational study. Demographic and treatment data were collected. The Confusion Assessment Method for ICU (CAM-ICU) was performed twice daily to assess for delirium continuously during a 3-week period. Statistical analysis was used to determine the relationship between risk factors and the occurrence of delirium. Results: 86 patients were screened, 44 patients were included, and 260 patient-days were analyzed. The incidence of delirium was 42.9%, the prevalence of delirium in ICU was 50%. Urinary catheters and use of opioids were the most common factors with a positive association for occurrence of delirium. Exposure to daylight and sleeping for more than 4 hours at night were the factors most commonly associated with a lack of delirium. Conclusion: The rates of delirium in ICU were high and risk factors occurred frequently. Addressing modifiable risk factors, including the promotion of adequate sleep, could improve outcomes.

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals MP30: Validation of the 4AT questionnaire in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S75
Author(s):  
A. Gagné ◽  
P. Voyer ◽  
V. Boucher ◽  
M. Pelletier ◽  
E. Gouin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cognitive Impairment ◽  
Telephone Interview ◽  
Rapid Assessment ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Status ◽  
French Version ◽  
Elderly Inpatients ◽  
Patients At Risk

Introduction: Delirium is a very prevalent cognitive impairment in elderly inpatients, but it often goes undetected, especially in the emergency department (ED). The tools currently available to screen or diagnose patients at risk of delirium are very time-consuming and are impossible to systematically perform in the ED environment. For this reason, short tests are necessary to screen for delirium in this fast-paced setting. The objective of this study was to evaluate the performance of the French version of the Rapid Assessment Test for Delirium (4AT) for the detection of delirium and cognitive impairment in older patients. The 4AT takes less than 2 minutes to administer, which is a great advantage on the others tests. Methods: The study was conducted in four emergency departments across the province of Québec. Participants were independent or semi-independent patients aged 65 and older, admitted to hospital and who had an 8-hour exposure to the ED. The Telephone Interview for Cognitive Status (TICS) was administered at the initial interview and the Confusion Assessment Method (CAM) as well as the 4AT were administered to patients twice a day during their ED or hospital stay. The 4AT’s sensitivity and specificity were compared to that of the CAM (for delirium), and to that of the TICS (for cognitive impairment). Results: 324 patients were included in the study, with a mean age of 76 years old. Among the recruited participants, 21 (6.5%) had a prevalent delirium according to the CAM, and 30 (10.2%) had an incident delirium. According to the 4AT, 48 patients (14.9%) had cognitive impairment and 81 (25.2%) had a prevalent delirium. According to the TICS, 87 patients (29.2%) have cognitive impairment. The 4AT has a sensitivity of 68,4% (IC 95% : 47,5-89,3) and a specificity of 73.2% (IC 95% : 67,8-78,7) for delirium, and a sensitivity of 50% (IC 95% : 35,9-64,1) and a specificity of 87,0% (IC 95% : 81,2-92) for cognitive impairment. Conclusion: The French Version of the 4AT could be a fast and reliable screening tool for delirium and cognitive impairment in ED. Further research is necessary for its validation in the ED.

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