Delirium: moving beyond the clinical diagnosis

Coulson, Brett; Almeida, Osvaldo P.

doi:10.1590/s1516-44462002000500007

Cited by 4 publications

(1 citation statement)

References 47 publications

(49 reference statements)

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“…A síndrome do Delirium é descrita como agitação psicomotora ou hipoatividade e incapacidade de manter contato com o ambiente externo, diferencia-se de confusão mental por ter curso flutuante e fatores predisponentes característicos, podendo ser observada principalmente em pacientes com longa permanência em UTI [8]. Tais sintomas podem ser observados em uma incidência de 14,0 a 56,0%, sendo ainda maior se pesquisado apenas em pacientes idosos, fator que agrava a probabilidade da ocorrência e evolução da síndrome [9].…”

Section: Introductionunclassified

Ocorrência do delirium nas unidades de terapia intensiva

Garnett

Cardoso

2014

Enferm Bras

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Caracterizado pelo curso flutuante e diminuição no nível de consciência, o delirium é considerado uma alteração neurológica que acomete principalmente idosos institucionalizados. Este estudo teve como objetivo buscar nas produções científicas a ocorrência da clínica delirium em unidades de terapia intensiva (UTI) e a atuação da enfermagem frente esta síndrome. Foram selecionados 35 artigos utilizando os descritores na língua portuguesa, inglesa e espanhola na base de dados do Google Acadêmico e Biblioteca Virtual em Saúde (BVS), Pubmed, Scientific Eletronic Library Online (Scielo), Medline, Lilacs e Ibecs. Destes 45% abordam sobre a assistência de enfermagem para pacientes com delirium, 40% abordam a ocorrência do delirium de pacientes em UTI e 15% abordando a assistência de enfermagem e ocorrência do delirium em UTI. Dos artigos analisados observou-se que a abordagem descreve sobre a história desta clínica, sua fisiopatologia e diagnóstico médico destacando a elevada incidência e o desconhecimento por parte dos profissionais acerca deste distúrbio que permanece subdiagnosticado. Sobre a assistência de enfermagem, destacamos a não existência de protocolos, condutas de enfermagem, treinamentos ou sugestão de conduta frente à ocorrência de delirium, permitindo inferir a necessidade de novos estudos no direcionamento da assistência de enfermagem na detecção do delirium.Palavras-chave: delirium, unidades de terapia intensiva, assistência de enfermagem.

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Section: Introductionunclassified

Ocorrência do delirium nas unidades de terapia intensiva

Garnett

Cardoso

2014

Enferm Bras

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From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account

Sideris

2018

Med Humanities

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This paper tells the story of one man's experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces emotional suffering severe enough to be identified as post-traumatic stress disorder (PTSD). A body of international research, confirmed by South African studies, links life-saving critical care to symptoms which qualify for secondary psychiatric diagnosis including of post-traumatic stress. Risk factors include pre-ICU comorbid psychopathology. Early on in the clinical encounter with the patient in this paper it emerged that he bore the scars of another trauma. He had been a soldier. Recounting the terror he experienced when he was being weaned off mechanical ventilation evoked memories of his military history. Paradoxically, these shifted the focus away from the symptoms of PTSD, to make the helplessness and dependency of ICU patients more visible. This patient's clinical account and patient experiences in other studies reveal the relational vulnerability of ICU patients. In as much as experiences of ICU treatment can be terrifying, the non-response of carers distresses patients. This interplay of wounding and care provides a starting point from which to explore how we account for the neglect of relational care that is a recurring theme in medical contexts, without blaming the carers. These questions find resonance in a South African novel to which the paper refers. A novel about war and trauma movingly portrays the internal conflict of the central character, a nurse and her quest not to care, as a defence against vulnerability. In these ways writing about the relational vulnerability of patients opened up questions about the social and institutional context of carer vulnerability.

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The frequency and quality of delirium documentation in discharge summaries

Chuen

Chan

et al. 2021

BMC Geriatr

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Background The National Institute for Health and Care Excellence recommends documenting all delirium episodes in the discharge summary using the term “delirium”. Previous studies demonstrate poor delirium documentation rates in discharge summaries and no studies have assessed delirium documentation quality. The aim of this study was to determine the frequency and quality of delirium documentation in discharge summaries and explore differences between medical and surgical services. Methods This was a multi-center retrospective chart review. We included 110 patients aged ≥ 65 years identified to have delirium during their hospitalization using the Chart-based Delirium Identification Instrument (CHART-DEL). We assessed the frequency of any delirium documentation in discharge summaries, and more specifically, for the term “delirium”. We evaluated the quality of delirium discharge documentation using the Joint Commission on Accreditation of Healthcare Organization’s framework for quality discharge summaries. Comparisons were made between medical and surgical services. Secondary outcomes included assessing factors influencing the frequency of “delirium” being documented in the discharge summary. Results We identified 110 patients with sufficient chart documentation to identify delirium and 80.9 % of patients had delirium documented in their discharge summary (“delirium” or other acceptable term). The specific term “delirium” was reported in 63.6 % of all delirious patients and more often by surgical than medical specialties (76.5 % vs. 52.5 %, p = 0.02). Documentation quality was significantly lower by surgical specialties in reporting delirium as a diagnosis (23.5 % vs. 57.6 %, p < 0.001), documenting delirium workup (23.4 % vs. 57.6 %, p = 0.001), etiology (43.3 % vs. 70.4 %, p = 0.03), treatment (36.7 % vs. 66.7 %, p = 0.02), medication changes (44.4 % vs. 100 %, p = 0.002) and follow-up (36.4 % vs. 88.2 %, p = 0.01). Conclusions The frequency of delirium documentation is higher than previously reported but remains subpar. Medical services document delirium with higher quality, but surgical specialties document the term “delirium” more frequently. The documentation of delirium in discharge summaries must improve to meet quality standards.

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Delirium: moving beyond the clinical diagnosis

Cited by 4 publications

References 47 publications

Ocorrência do delirium nas unidades de terapia intensiva

Ocorrência do delirium nas unidades de terapia intensiva

From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account

The frequency and quality of delirium documentation in discharge summaries

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