Characteristics of Hospitalized Patients Screening Positive for Delirium

Abstract

Background: Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations. Objective: To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use. Design, Settings, Patients: Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized. Measurements: Patients’ demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams’ involvement. Results: Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations. Conclusion: In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.

A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

“…Study inclusion criteria were: (1) hospitalised patients aged ≥18 years diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Statistical Classification of Diseases and Health Related Problems (ICD) criteria, or validated tool, including the Confusion Assessment Method (CAM) 7 or CAM for the Intensive Care Unit (CAM-ICU), 17 Delirium Rating Scale Revised-98 (DRS-R98), 18 Nursing Delirium Screening Scale (Nu-DESC), 19 Memorial Delirium Assessment Scale (MDAS), 20 4AT 6 and Delirium Index (DI) 21 ; (2) baseline data from point of diagnosis of delirium or initial delirium assessment; (3) data from at least one repeated assessment within seven days from baseline (a clinically applicable timeframe; the average delirium episode has been suggested to be ~seven days 22 ); studies with further assessments beyond seven days were excluded; (4) data collected using neuropsychological assessment tools on at least one symptom domain of delirium (including general cognition, language, attention, level of arousal, memory, orientation, affect and distress), or tools measuring functional ability (e.g., mobility) in the context of repeated assessments. Studies reporting the overall score of a delirium-specific assessment tool (such as the DRS-R98) without reporting change in the individual neuropsychological or functional domains measured by the tool were excluded.…”

Impact of Pain, Agitation, and Delirium Bundle on Delirium and Cognitive Function

“…Given their critical status, which may include immobility, metabolic disorder, or being under the influence of medications, critically ill patients in the ICU, especially patients with mechanical ventilation, are at a high risk of developing delirium. The incidence of delirium in patients with mechanical ventilation has been reported to be 60% or higher (Li et al, 2018; Nguyen et al, 2020). Studies have shown that ICU delirium is an independent predictor in ICU patients of poor clinical prognoses such as prolonged mechanical ventilation, prolonged length of stay (LOS) in the ICU and the hospital, higher healthcare costs, and increased mortality (Marra et al, 2017; Senel et al, 2017).…”