Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?
Abstract Background Retrospective studies estimate Emergency Department (ED) delirium recognition at
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| Veröffentlicht in: | Age and ageing 2022-02, Vol.51 (2) |
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| creator | Lee, Jacques S Tong, Tiffany Chignell, Mark Tierney, Mary C Goldstein, Judah Eagles, Debra Perry, Jeffrey J McRae, Andrew Lang, Eddy Hefferon, Darren Rose, Louise Kiss, Alex Borgundvaag, Bjug McLeod, Shelley Melady, Don Boucher, Valérie Sirois, Marie-Josée Émond, Marcel |
| description | Abstract
Background
Retrospective studies estimate Emergency Department (ED) delirium recognition at |
| doi_str_mv | 10.1093/ageing/afab214 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2628299932</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ageing/afab214</oup_id><sourcerecordid>2628299932</sourcerecordid><originalsourceid>FETCH-LOGICAL-c397t-91fcba86f7ada89d97c19ddc0c90d948639b16c8290940a0a5071ced1a1c41ea3</originalsourceid><addsrcrecordid>eNqFkc1u1DAURi0EokNhyxJZYkOlprVjO4nZoKriT6oACVhHd-ybmVSxndoJo-GxeEKczsCCDSvryuc71_JHyHPOLjjT4hI22PvNJXSwLrl8QFZcVk1RNkI-JCvGWFmwutQn5ElKt3nkipePyYlQXDHVqBX59SXiDxjQGzynDnz2OfQTBW9pmCcTHCYaOjr7iCZsfP8TLbU49LGfHe09BfoJpj54GOhXcOOAC83PpRY0DBYjzb64yf59jo0Qp3v9mDP5TK_pNuyWvXu6w4g0LZfbvPT-Abst5AnGEX3eOgU6bdG9eUoedTAkfHY8T8n3d2-_XX8obj6__3h9dVMYoeup0Lwza2iqrgYLjba6Nlxba5jRzGrZVEKveWWaUjMtGTBQrOYGLQduJEcQp-TVwTvGcDdjmlrXJ4PDAB7DnNqyKnNYa1Fm9OU_6G2YY_6ThRKNUrJSMlMXB8rEkFLErh1j7yDuW87apc320GZ7bDMHXhy189qh_Yv_qS8DZwcgzOP_ZL8B1CutTQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2638554654</pqid></control><display><type>article</type><title>Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Lee, Jacques S ; Tong, Tiffany ; Chignell, Mark ; Tierney, Mary C ; Goldstein, Judah ; Eagles, Debra ; Perry, Jeffrey J ; McRae, Andrew ; Lang, Eddy ; Hefferon, Darren ; Rose, Louise ; Kiss, Alex ; Borgundvaag, Bjug ; McLeod, Shelley ; Melady, Don ; Boucher, Valérie ; Sirois, Marie-Josée ; Émond, Marcel</creator><creatorcontrib>Lee, Jacques S ; Tong, Tiffany ; Chignell, Mark ; Tierney, Mary C ; Goldstein, Judah ; Eagles, Debra ; Perry, Jeffrey J ; McRae, Andrew ; Lang, Eddy ; Hefferon, Darren ; Rose, Louise ; Kiss, Alex ; Borgundvaag, Bjug ; McLeod, Shelley ; Melady, Don ; Boucher, Valérie ; Sirois, Marie-Josée ; Émond, Marcel</creatorcontrib><description>Abstract
Background
Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium.
Objectives
To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes.
Methods
Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls).
Results
We enrolled 1,493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2–6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4–66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2–72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort.
Conclusion
Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afab214</identifier><identifier>PMID: 35150585</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Acknowledgment ; Aftercare ; Aged ; Clinical outcomes ; Confusion ; Delirium ; Delirium - diagnosis ; Delirium - epidemiology ; Delirium - therapy ; Diagnosis ; Emergency medical care ; Emergency Service, Hospital ; Emergency services ; Female ; Geriatric Assessment - methods ; Humans ; Medical diagnosis ; Nurses ; Patient Discharge ; Patients ; Physicians ; Prevalence ; Prospective Studies ; Retrospective Studies</subject><ispartof>Age and ageing, 2022-02, Vol.51 (2)</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-91fcba86f7ada89d97c19ddc0c90d948639b16c8290940a0a5071ced1a1c41ea3</citedby><cites>FETCH-LOGICAL-c397t-91fcba86f7ada89d97c19ddc0c90d948639b16c8290940a0a5071ced1a1c41ea3</cites><orcidid>0000-0002-7454-2721 ; 0000-0002-9143-6285 ; 0000-0001-7158-8110</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925,30999</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35150585$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Jacques S</creatorcontrib><creatorcontrib>Tong, Tiffany</creatorcontrib><creatorcontrib>Chignell, Mark</creatorcontrib><creatorcontrib>Tierney, Mary C</creatorcontrib><creatorcontrib>Goldstein, Judah</creatorcontrib><creatorcontrib>Eagles, Debra</creatorcontrib><creatorcontrib>Perry, Jeffrey J</creatorcontrib><creatorcontrib>McRae, Andrew</creatorcontrib><creatorcontrib>Lang, Eddy</creatorcontrib><creatorcontrib>Hefferon, Darren</creatorcontrib><creatorcontrib>Rose, Louise</creatorcontrib><creatorcontrib>Kiss, Alex</creatorcontrib><creatorcontrib>Borgundvaag, Bjug</creatorcontrib><creatorcontrib>McLeod, Shelley</creatorcontrib><creatorcontrib>Melady, Don</creatorcontrib><creatorcontrib>Boucher, Valérie</creatorcontrib><creatorcontrib>Sirois, Marie-Josée</creatorcontrib><creatorcontrib>Émond, Marcel</creatorcontrib><title>Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?</title><title>Age and ageing</title><addtitle>Age Ageing</addtitle><description>Abstract
Background
Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium.
Objectives
To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes.
Methods
Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls).
Results
We enrolled 1,493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2–6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4–66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2–72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort.
Conclusion
Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.</description><subject>Acknowledgment</subject><subject>Aftercare</subject><subject>Aged</subject><subject>Clinical outcomes</subject><subject>Confusion</subject><subject>Delirium</subject><subject>Delirium - diagnosis</subject><subject>Delirium - epidemiology</subject><subject>Delirium - therapy</subject><subject>Diagnosis</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Emergency services</subject><subject>Female</subject><subject>Geriatric Assessment - methods</subject><subject>Humans</subject><subject>Medical diagnosis</subject><subject>Nurses</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>Physicians</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><issn>0002-0729</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkc1u1DAURi0EokNhyxJZYkOlprVjO4nZoKriT6oACVhHd-ybmVSxndoJo-GxeEKczsCCDSvryuc71_JHyHPOLjjT4hI22PvNJXSwLrl8QFZcVk1RNkI-JCvGWFmwutQn5ElKt3nkipePyYlQXDHVqBX59SXiDxjQGzynDnz2OfQTBW9pmCcTHCYaOjr7iCZsfP8TLbU49LGfHe09BfoJpj54GOhXcOOAC83PpRY0DBYjzb64yf59jo0Qp3v9mDP5TK_pNuyWvXu6w4g0LZfbvPT-Abst5AnGEX3eOgU6bdG9eUoedTAkfHY8T8n3d2-_XX8obj6__3h9dVMYoeup0Lwza2iqrgYLjba6Nlxba5jRzGrZVEKveWWaUjMtGTBQrOYGLQduJEcQp-TVwTvGcDdjmlrXJ4PDAB7DnNqyKnNYa1Fm9OU_6G2YY_6ThRKNUrJSMlMXB8rEkFLErh1j7yDuW87apc320GZ7bDMHXhy189qh_Yv_qS8DZwcgzOP_ZL8B1CutTQ</recordid><startdate>20220202</startdate><enddate>20220202</enddate><creator>Lee, Jacques S</creator><creator>Tong, Tiffany</creator><creator>Chignell, Mark</creator><creator>Tierney, Mary C</creator><creator>Goldstein, Judah</creator><creator>Eagles, Debra</creator><creator>Perry, Jeffrey J</creator><creator>McRae, Andrew</creator><creator>Lang, Eddy</creator><creator>Hefferon, Darren</creator><creator>Rose, Louise</creator><creator>Kiss, Alex</creator><creator>Borgundvaag, Bjug</creator><creator>McLeod, Shelley</creator><creator>Melady, Don</creator><creator>Boucher, Valérie</creator><creator>Sirois, Marie-Josée</creator><creator>Émond, Marcel</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7454-2721</orcidid><orcidid>https://orcid.org/0000-0002-9143-6285</orcidid><orcidid>https://orcid.org/0000-0001-7158-8110</orcidid></search><sort><creationdate>20220202</creationdate><title>Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?</title><author>Lee, Jacques S ; Tong, Tiffany ; Chignell, Mark ; Tierney, Mary C ; Goldstein, Judah ; Eagles, Debra ; Perry, Jeffrey J ; McRae, Andrew ; Lang, Eddy ; Hefferon, Darren ; Rose, Louise ; Kiss, Alex ; Borgundvaag, Bjug ; McLeod, Shelley ; Melady, Don ; Boucher, Valérie ; Sirois, Marie-Josée ; Émond, Marcel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-91fcba86f7ada89d97c19ddc0c90d948639b16c8290940a0a5071ced1a1c41ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acknowledgment</topic><topic>Aftercare</topic><topic>Aged</topic><topic>Clinical outcomes</topic><topic>Confusion</topic><topic>Delirium</topic><topic>Delirium - diagnosis</topic><topic>Delirium - epidemiology</topic><topic>Delirium - therapy</topic><topic>Diagnosis</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Emergency services</topic><topic>Female</topic><topic>Geriatric Assessment - methods</topic><topic>Humans</topic><topic>Medical diagnosis</topic><topic>Nurses</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>Physicians</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Jacques S</creatorcontrib><creatorcontrib>Tong, Tiffany</creatorcontrib><creatorcontrib>Chignell, Mark</creatorcontrib><creatorcontrib>Tierney, Mary C</creatorcontrib><creatorcontrib>Goldstein, Judah</creatorcontrib><creatorcontrib>Eagles, Debra</creatorcontrib><creatorcontrib>Perry, Jeffrey J</creatorcontrib><creatorcontrib>McRae, Andrew</creatorcontrib><creatorcontrib>Lang, Eddy</creatorcontrib><creatorcontrib>Hefferon, Darren</creatorcontrib><creatorcontrib>Rose, Louise</creatorcontrib><creatorcontrib>Kiss, Alex</creatorcontrib><creatorcontrib>Borgundvaag, Bjug</creatorcontrib><creatorcontrib>McLeod, Shelley</creatorcontrib><creatorcontrib>Melady, Don</creatorcontrib><creatorcontrib>Boucher, Valérie</creatorcontrib><creatorcontrib>Sirois, Marie-Josée</creatorcontrib><creatorcontrib>Émond, Marcel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Jacques S</au><au>Tong, Tiffany</au><au>Chignell, Mark</au><au>Tierney, Mary C</au><au>Goldstein, Judah</au><au>Eagles, Debra</au><au>Perry, Jeffrey J</au><au>McRae, Andrew</au><au>Lang, Eddy</au><au>Hefferon, Darren</au><au>Rose, Louise</au><au>Kiss, Alex</au><au>Borgundvaag, Bjug</au><au>McLeod, Shelley</au><au>Melady, Don</au><au>Boucher, Valérie</au><au>Sirois, Marie-Josée</au><au>Émond, Marcel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?</atitle><jtitle>Age and ageing</jtitle><addtitle>Age Ageing</addtitle><date>2022-02-02</date><risdate>2022</risdate><volume>51</volume><issue>2</issue><issn>0002-0729</issn><eissn>1468-2834</eissn><abstract>Abstract
Background
Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium.
Objectives
To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes.
Methods
Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls).
Results
We enrolled 1,493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2–6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4–66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2–72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort.
Conclusion
Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>35150585</pmid><doi>10.1093/ageing/afab214</doi><orcidid>https://orcid.org/0000-0002-7454-2721</orcidid><orcidid>https://orcid.org/0000-0002-9143-6285</orcidid><orcidid>https://orcid.org/0000-0001-7158-8110</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acknowledgment Aftercare Aged Clinical outcomes Confusion Delirium Delirium - diagnosis Delirium - epidemiology Delirium - therapy Diagnosis Emergency medical care Emergency Service, Hospital Emergency services Female Geriatric Assessment - methods Humans Medical diagnosis Nurses Patient Discharge Patients Physicians Prevalence Prospective Studies Retrospective Studies |
| title | Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them? |
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