BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

Compared with usual nutritional care, energy- and protein-based fortification and supplementation could be employed as an effective, well-tolerated and cost-effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes.

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BackgroundAntibiotics are overused in patients hospitalized with acute respiratory illness (ARI). Diagnostic uncertainty regarding microbial etiology contributes to this practice and so a host response test that can distinguish between viral and bacterial infection has the potential to reduce unnecessary antibiotic use. The FebriDx is a low cost, rapid, host response POCT that uses fingerpick blood samples to distinguish between viral and bacterial infection but has not been evaluated in hospitalized adults with ARI.MethodsWe took fingerpick blood samples from adult patients with ARI, hospitalized during influenza season, and tested them on the FebriDx. Respiratory samples were tested for viruses on the FilmArray Respiratory Panel (FARP). The FebriDx was evaluated for ease of use, failure rate and accuracy of the results (Viral, Bacterial, Negative).Results149 patients were approached and 10 patients declined fingerpick testing. A valid result was obtained from 124/139 (89%) overall. Common user comments included test failure due to difficulty of getting blood to fill the capillary tube and difficulty in interpreting the results lines due to the variability of color change. 111/124 (89%) were tested for viruses by FARP. 69/111 (62%) had viruses detected. Of 69 patients with viruses detected, 41 (59%) had influenza, 12 (17%) rhino/enterovirus and 16 (23%) other viruses. 44/69 (64%) had a viral FebriDx result. For influenza-positive patients 34/41 (83%) had a viral FebriDx result, 1/12(8%) of rhinovirus-positive patients had a viral FebriDx result and 9/16 (56%) of patients with other viruses detected had a viral FebriDx result. These are interim results. Full results for 200 patients will be available at presentation.ConclusionThe use of the FebriDx POC was associated with a failure rate of ~10% and problems with the interpretation of result lines. FebriDx was not sufficiently accurate in differentiating viral and bacterial infection when using detection of virus by PCR as the definition of viral infection; however, FebriDx had a high PPV for all viral detection and for influenza detection in this cohort and could have utility in hospital emergency departments. Disclosures All authors: No reported disclosures.