Delirium motor subtypes in elderly hip fracture patients: Risk factors, outcomes and longitudinal stability

Slor, Chantal J.; Adamis, Dimitrios; Jansen, René W. M. M.; Meagher, David; Witlox, Joost; Houdijk, Alexander P. J.; Jonghe, Jos F. M. de

doi:10.1016/j.jpsychores.2012.12.007

Cited by 30 publications

(34 citation statements)

References 29 publications

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“…Previous research showed that duration and severity of delirium were associated with change of subtype; this was not demonstrated in this study. The association found between no motor subtype and lower DRS‐R98 score could have caused confounding.…”

Section: Discussioncontrasting

confidence: 91%

“…Previous research has shown contradictory results with regard to changes in subtypes . Differences in methodology could explain this.…”

Section: Discussionmentioning

confidence: 88%

“…Some have found that symptoms, such as hypoactivity, remained stable across assessments; others reported that most assessments had mixed features . A study of individuals with hip fracture found substantial variability in motor subtypes, as evidenced by changing subtype profile in 86% of participants. Subtype variability was linked to duration of delirium and to number of assessments conducted.…”

mentioning

confidence: 99%

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Variability of Delirium Motor Subtype Scale–Defined Delirium Motor Subtypes in Elderly Adults with Hip Fracture: A Longitudinal Study

Scholtens

Munster

Adamis

et al. 2016

J American Geriatrics Society

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Motor subtype profile was variable in the majority of participants, although changes that occurred were often related to changes from or to no motor subtype, suggesting evolving or resolving delirium. Changes appeared not be associated with demographic or clinical characteristics, suggesting that evidence from cross-sectional studies of motor subtypes could be applied to many individuals with delirium. Further longitudinal studies should be performed to clarify the stability of motor subtypes in different clinical populations.

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Section: Discussioncontrasting

confidence: 91%

“…Previous research has shown contradictory results with regard to changes in subtypes . Differences in methodology could explain this.…”

Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

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Variability of Delirium Motor Subtype Scale–Defined Delirium Motor Subtypes in Elderly Adults with Hip Fracture: A Longitudinal Study

Scholtens

Munster

Adamis

et al. 2016

J American Geriatrics Society

Self Cite

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“…However, the relevance of such phenotypes to outcomes is controversial . Three studies showed a higher mortality in patients with hypoactive delirium, one reported an increased mortality after hyperactive delirium in surgical patients, and three others failed to demonstrate any association between delirium phenotypes and outcomes . Our study did not find any association of delirium phenotype with hospital mortality or on delirium recovery.…”

Section: Discussioncontrasting

confidence: 75%

Differential clinical characteristics, management and outcome of delirium among ward compared with intensive care unit patients

Canet

Amjad

Robbins

et al. 2019

Internal Medicine Journal

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Background Delirium is common in hospitalised patients but its epidemiology remains poorly characterised. Aims To test the hypothesis that patient demographics, clinical phenotype, management and outcomes of patient with delirium in hospital ward patients differ from intensive care unit (ICU) patients. Methods Retrospective cohort of patients admitted to an Australian university‐affiliated hospital between March 2013 and April 2017 and coded for delirium at discharge using the International Classification of Diseases System, 10th revision, criteria. Results Among 61 032 hospitalised patients, 2864 (4.7%) were coded for delirium. From these, we studied a random sample of 100 ward patients and 100 ICU patients. Ward patients were older (median age: 84 vs 65 years; P < 0.0001), more likely to have dementia (38% vs 2% for ICU patients; P < 0.0001) and less likely to have had surgery (24% vs 62%; P < 0.0001). Of ward patients, 74% had hypoactive delirium, while 64% of ICU patients had agitated delirium (P < 0.0001). Persistent delirium at hospital discharge was more common among ward patients (66% vs 17%, P < 0.0001). On multivariable analysis, age and dementia predicted persistent delirium, while surgery predicted recovery. Conclusions Delirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection and goals of care should be adapted to the environment in which it occurs.

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“…Delirium diagnosis was further categorized into hypoactive, hyperactive, and mixed subtypes based on DSM-5 definitions using DRS-R98 categories. 31,32 …”

Section: Methodsmentioning

confidence: 99%

Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients

et al. 2017

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Background Guidelines recommend daily delirium monitoring of hospitalized patients. Available delirium-screening tools have not been validated for use by nurses among diverse inpatients. Objective We sought to validate the Nursing Delirium-Screening Scale (Nu-DESC) under these circumstances. Methods A blinded cross-sectional and quality-improvement study was conducted from August 2015–February 2016. Nurses’ Nu-DESC scores were compared to delirium diagnosis according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria. A total of 405 consecutive hospitalized patients were included. Nu-DESC-positive (threshold score ≥2) patients were matched with equal numbers of Nu-DESC-negative patients, by sex, age, and nursing unit. Nurses recorded a Nu-DESC score for each patient on every 12-hour shift. A Nu-DESC-blinded evaluator interviewed patients for 2 consecutive days. Delirium diagnosis was determined by physicians using DSM-5 criteria applied to collected research data. Sensitivity and specificity of the Nu-DESC were calculated. In an exploratory analysis, the performance of the Nu-DESC was analyzed with the addition of bedside measures of attention. Results The sensitivity of the Nu-DESC at a threshold of ≥2 was 42% (95% CI: 33–53%). Specificity was 98% (97– 98%). At a threshold of ≥1, sensitivity was 67% (52– 80%) and specificity 93% (90–95%). Similar results were found with the addition of attention tasks. Conclusion The Nu-DESC is a specific delirium detection tool, but it is not sensitive at the usually proposed cut point of ≥2. Using a threshold of ≥1 or adding a test of attention increase sensitivity with a minor decrease in specificity.

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Delirium motor subtypes in elderly hip fracture patients: Risk factors, outcomes and longitudinal stability

Cited by 30 publications

References 29 publications

Variability of Delirium Motor Subtype Scale–Defined Delirium Motor Subtypes in Elderly Adults with Hip Fracture: A Longitudinal Study

Variability of Delirium Motor Subtype Scale–Defined Delirium Motor Subtypes in Elderly Adults with Hip Fracture: A Longitudinal Study

Differential clinical characteristics, management and outcome of delirium among ward compared with intensive care unit patients

Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients

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