Abstract
Background
It is documented that health professionals from various settings fail to detect > 50%
of delirium cases.
Objective
This study aimed to describe the proportion of unrecognized incident delirium in five
emergency departments (EDs). Secondary objectives were to compare the two groups (recognized/unrecognized)
and assess the impact of unrecognized delirium at 60 days regarding 1) unplanned consultations
and 2) functional and cognitive decline.
Method
This is a sub-analysis of a multicenter prospective cohort study. Independent patients
aged ≥ 65 years who tested negative for delirium on the initial interview with an
ED stay ≥ 8 h were enrolled. Patients were assessed twice daily using the Confusion
Assessment Method (CAM) and the Delirium Index up to 24 h into hospital admission.
Medical records were reviewed to assess whether delirium was recognized or not.
Results
The main study reported a positive CAM in 68 patients. Three patients’ medical files
were incomplete, leaving a sample of 65 patients. Delirium was recognized in 15.4%
of our participants. These patients were older (p = 0.03) and female (p = 0.01) but were otherwise similar to those with unrecognized delirium. Delirium
Index scores were higher in patients with recognized delirium (p = 0.01) and they experienced a more important functional decline at 60 days (p = 0.02). No association was found between delirium recognition and health care services
utilization or decline in cognitive function.
Conclusions
This study confirms reports of high rates of missed or unrecognized delirium (84.6%)
in ED patients compared to routine structured screening using the CAM performed by
a research assistant. Patients with recognized delirium were older women with a greater
severity of symptoms and experienced a more significant functional decline at 60 days.
Keywords
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Article info
Publication history
Published online: July 25, 2019
Accepted:
May 6,
2019
Received in revised form:
April 30,
2019
Received:
August 22,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
