patients in middle income countries remains unclear. We sought to determine the prevalence of delirium and how often it is unrecognized in the ED. A secondary objective was to identify risk factors and short term outcomes in delirious elderly ED patients in a middle income country. Methods: This was a prospective cross-sectional study in the ED of an urban, tertiary care hospital with an annual census of 70,000 patients. We collected data from a convenience sample of patients between 8:00 am and 12:00 pm, from June 1, 2013 through July 15, 2013. Patients aged 65 years who presented to the ED were included. We excluded patients who had severe dementia, were unarousable to verbal stimuli for all delirium assessments, had severe trauma, and were blind, deaf, aphasic, or unable to speak Thai. We used the Short Portable Mental Status Questionnaire (SPMSQ) for screening patients' capacity to give informed consent. Delirium was determined using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by trained research assistants. Multivariable logistic regression was used to identify delirium risk factors. We collected 30-day mortality rate, revisit rate, and hospital length of stay as shortterm outcomes. Results: We had a final sample size of 232 patients; 27 (12%) were delirious in the ED, of which 16 (59%) were not recognized to be delirious by the emergency physician. Eleven (41%) of these delirious patients were discharged home. Dementia (adjusted OR ¼ 13; 95% CI 2.5-59.6), hearing impairment (adjusted OR¼ 4.7; 95% CI 1.6-13.8) and ED diagnosis of metabolic disturbance (adjusted OR¼ 6.5; 95% CI 1.6-26.8) were independently associated with delirium in ED. During the 30-day follow-up, delirium was associated with a higher mortality rate than those without delirium (14.8% versus 1.5%; P¼.004). Conclusion: Delirium was a common occurrence in the ED. Emergency physicians missed delirium in 59% of cases. Short-term mortality rate was increased in delirious elderly ED patients. There needs to be improved delirium screening; focusing on high risk patients may improve ED delirium screening efficiency.
Conclusion:In this prospective study of LAMS performed by EMS personnel for all suspected stroke calls, the authors demonstrate that the out-of-hospital LAMS correlates well with the hospital NIHSS, and as such can be viewed as a marker of stroke severity.
Elder mistreatment (EM) is a public health problem that is rarely recognized or addressed in emergency departments (ED) where a lack of evidence-based protocols leave clinicians to rely on intuition and inconsistent action plans. In this presentation we will share findings from focus groups and online surveys with ED clinicians and administrators to evaluate the perceived value and likelihood of adopting the National Collaboratory’s third core element: the EM Screening and Response Protocol (EM-SAR). Results indicated a strong support for the EM-SAR tool in general and highlighted specific considerations for refining the tool. Considerations include resistance to adding to the ED workload, need to clarify roles and responsibilities for administering the tool, hesitancy to rely on clinical judgement to assess EM, concerns over Adult Protective Services’ ability to respond to increased reports, and a desire for cross-training and cooperation. These findings and implications for ongoing feasibility testing will be discussed.
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