scholarly journals Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 903-910 ◽  
Author(s):  
Anne-Julie Gagné ◽  
Philippe Voyer ◽  
Valérie Boucher ◽  
Alexandra Nadeau ◽  
Pierre-Hugues Carmichael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Systematic Screening ◽  
French Version ◽  
Administration Time ◽  
Older Inpatients ◽  
Patients At Risk

CLINICIAN’S CAPSULEWhat is known about the topic?Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A’s Test (4AT), was created and validated for the detection of delirium.What did this study ask?This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium.What did this study find?The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED).Why does this study matter to clinicians?Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.

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.

scholarly journals Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

2019 ◽  
Vol 49 (1) ◽  
pp. 130-134
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Primary Outcome ◽  
Screening Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multicenter Cohort Study ◽  
Delirium Assessment ◽  
Lengths Of Stay ◽  
History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

54 No One Told Me I Couldn’t Drive with Delirium

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Watson ◽  
L Ralston
Keyword(s):  
Screening Tool ◽  
Hospital Admissions ◽  
District General Hospital ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Lead Author ◽  
Common Cause ◽  
Confusion Assessment ◽  
Number Of Patients ◽  
Patients At Risk

Abstract Introduction Delirium is a common cause and complication of hospital admissions. DVLA1, and Consensus guidelines2 exist for driving with dementia or mild cognitive impairment, but there are no specific guidelines pertaining to delirium. This audit set out to find the prevalence of delirium in a district general hospital prior to implementation of a standard screening tool. It was noteworthy that a significant number of patients with delirium were drivers. Methods The notes of 114 patients under the care of nine specialties, both medical and surgical were prospectively reviewed. Of those with risk factors for delirium, data was collected on the number of patients who had a diagnosis of delirium made during their admission. For patients at risk with no documented screening already completed a Confusion Assessment Method (CAM) screening test was performed by the lead author. In patients identified with delirium it was also established if they were current drivers via clerking documentation or by discussion with the patient/family. Drivers with delirium were highlighted in the medical notes and where possible discussions were had with the patient and their families regarding driving advice until the delirium had resolved. Results The prevalence of delirium in this group was 23% (n = 26/114). 20 patients had documented evidence of delirium and a further 6 patients were diagnosed as a result of this project. 15.4% (n = 4/26) of patients with delirium were current drivers. For this group there was no documented evidence that driving advice had been given to the patient or family. Conclusion This baseline audit has identified that delirium is not consistently screened for and identified. In patients with delirium, driving history is not being sought and consequently the opportunity for driving advice is being missed. Clear guidance from the DVLA on driving for patients with a resolving delirium is needed. References 1. DVLA, 2018. 2. RCPsych, 2019.

Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

2018 ◽  
Vol 31 (2) ◽  
pp. 267-276 ◽  
Author(s):  
Jamie Cirbus ◽  
Alasdair M. J. MacLullich ◽  
Christopher Noel ◽  
E. Wesley Ely ◽  
Rameela Chandrasekhar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergency Department Patients ◽  
Factor Interactions

ABSTRACTBackground:Delirium is heterogeneous and can vary by etiology.Objectives:We sought to determine how delirium subtyped by etiology affected six-month function and cognition.Design:Prospective cohort study.Setting:Tertiary care, academic medical center.Participants:A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED).Measurements:The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition.Results:In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (β coefficient = −2.9 points, 95%CI: −0.3 to −5.6) and organ dysfunction (β coefficient = −4.3 points, 95%CI: −7.2 to −1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (β coefficient = 0.69, 95%CI: 0.19 to 1.20).Conclusions:Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.

scholarly journals Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

2019 ◽  
Vol 9 (2) ◽  
pp. 236-249 ◽  
Author(s):  
Sandra Choutko-Joaquim ◽  
Nadine Tacchini-Jacquier ◽  
Géraldine Pralong D’Alessio ◽  
Henk Verloo
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multiple Chronic Conditions ◽  
Cross Sectional ◽  
Subsyndromal Delirium ◽  
Clinical Difference

Background: Switzerland’s demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium. Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland. Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants’ cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant’s most significant informal caregiver. Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference. Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

scholarly journals Validation of the Confusion Assessment Method for the Intensive Care Unit in Older Emergency Department Patients

2014 ◽  
Vol 21 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Jin H. Han ◽  
Amanda Wilson ◽  
Amy J. Graves ◽  
Ayumi Shintani ◽  
John F. Schnelle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Emergency Department Patients

scholarly journals Twelve-Month Mortality Among Delirium Subtypes

2011 ◽  
Vol 20 (4) ◽  
pp. 404-421 ◽  
Author(s):  
Susan K. DeCrane ◽  
Kennith R. Culp ◽  
Bonnie Wakefield
Keyword(s):  
Statistical Significance ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Term Care ◽  
International Classification Of Disease ◽  
Subsyndromal Delirium ◽  
Icd 10 ◽  
Underlying Cause Of Death ◽  
State Examination

This study used data from the Delirium Among the Elderly in Rural Long-Term Care Facilities Study and data from the National Death Index (NDI) to examine mortality among 320 individuals. Individuals were grouped into noncases, subsyndromal cases, hypoactive delirium, hyperactive delirium, and mixed delirium on the basis of scoring using the Confusion Assessment Method (CAM), NEECHAM Scale, Mini-Mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Risk ratios of mortality using “days of survival” did not reach statistical significance (α = .05) for any subgroup. Underlying cause of death (UCD) using International Classification of Disease, 10th version (ICD-10), showed typical UCD among older adults. There appeared to be clinical differences in UCD between delirium subgroups. Findings supported the conclusion that careful monitoring of patients with delirium and subsyndromal delirium is needed to avoid complications and injuries that could increase mortality.

scholarly journals Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) completion on an acute care ward for the elderly: a brief study of informant characteristics

2012 ◽  
Vol 24 (10) ◽  
pp. 1700-1701 ◽  
Author(s):  
K. Bloomfield ◽  
N. John
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Screening ◽  
Screening Algorithm ◽  
Drawing Task ◽  
The Uk ◽  
State Examination

Over recent years in the UK, emphasis has been placed on appropriate diagnosis and referral of patients with dementia. In guidelines published by the British Geriatrics Society (BGS) and Faculty of Old Age Psychiatrists consensus group (Forsyth et al., 2006), a cognitive screening algorithm was developed, which consists of initial screening for cognitive impairment with the Mini-Mental State Examination (MMSE) and CLOX1 (an executive clock drawing task). If the scores meet cut-off points indicated in the algorithm (MMSE <24 or CLOX1 <11), further assessments with the Confusion Assessment Method (CAM) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are applied with the aim to differentiate between delirium (CAM positive, IQCODE negative), delirium and chronic impairment (CAM positive, IQCODE positive), or chronic cognitive impairment (CAM negative, IQCODE positive).

Decisional capacity in patients with acute delirium. A Rawlsian approach

2017 ◽  
Vol 41 (S1) ◽  
pp. S581-S581
Author(s):  
S. Hostiuc ◽  
I. Negoi ◽  
E. Drima
Keyword(s):  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Ethical Principle ◽  
Point Of View ◽  
Practical Implementation ◽  
Decisional Capacity ◽  
Confusion Assessment ◽  
Competing Interest ◽  
Proper Analysis

Delirium is characterized by a temporary, usually reversible, cause of mental alteration; it can occur at any age, but affect most often the elderly. Delirium patients may also present acute psychotic episodes, which might make them decisionally incompetent. In order to assess decisional capacity, Fan et al developed a two-stage approach, which tries to analyse:– the presence of delirium, using the Confusion Assessment Method;– a proper analysis of the decisional capacity.Often, in patients with decreased decisional capacity, physicians must assess which ethical principle should respect first – the principle of autonomy, whose practical implementation is informed consent, or beneficence – the good of the patient, irrespective of the its declared wishes. In this poster, we will look at the issue of decisional capacity in patients with acute delirium from a Rawlsian point of view, and will try to give an answer based on what is just – to respect the autonomy of the patient, or the moral duty to do good to the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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