Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study

Aslaner, Mehmet Ali; Boz, Mustafa; Çelik, Ali; Ahmedali, Asliddin; Eroğlu, Sercan; Aksu, Nalan Metin; Eroğlu, Serkan Emre

doi:10.1016/j.ajem.2016.10.004

Cited by 35 publications

(60 citation statements)

References 25 publications

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“…The majority of studies did not present sufficient information to allow us to comment on the presence of delirium, but it is established that acuteonset reduced level of arousal, in non-comatose patients, is a highly specific indicator of delirium [4,5,8,13]. Only two [4,34] of the included studies looked for delirium amongst their patients. Many studies of delirium specifically exclude patients with reduced level of arousal [19].…”

Section: Interpretation and Implications For Clinical Practice And Fumentioning

confidence: 99%

“…Delirium is also associated with increased mortality [15][16][17][18] and the majority of patients with acute-onset reduced level of arousal meet criteria for delirium [4,5,8,13]. Additionally, some delirium studies exclude patients with severely reduced level of arousal [19]; this restricted spectrum may have led to underestimation of the relationship between delirium diagnosis and mortality.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…Many studies of delirium explicitly exclude people who are too drowsy to be tested [19], meaning studies of delirium and mortality are more difficult to interpret. Reduced level of arousal of acute onset, in the absence of trauma, is highly specific to delirium [4,5,8]. Hypoactive delirium is less likely to be recognised than cases with hyperactive features [2,20,21] and has poorer outcomes [18,21,22].…”

mentioning

confidence: 99%

“…GCS, AVPU, RASS or OSLA) or (ii) a subjective description (e.g. drowsy), (4) in-hospital mortality data comparing a drowsy group with a non-drowsy or less drowsy group.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…The review included 21 studies, eight of which comprised unselected medical admissions [4,[10][11][12][26][27][28][29] and 13 which considered specific medical conditions [30][31][32][33][34][35][36][37][38][39][40][41][42]. All were cohort studies; 11 prospective and 10 retrospective.…”

Section: Study Characteristicsmentioning

confidence: 99%

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57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

2018

Age and Ageing

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Background: Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods: We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results: From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 -83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions: Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.

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Section: Interpretation and Implications For Clinical Practice And Fumentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

mentioning

confidence: 99%

“…GCS, AVPU, RASS or OSLA) or (ii) a subjective description (e.g. drowsy), (4) in-hospital mortality data comparing a drowsy group with a non-drowsy or less drowsy group.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

2018

Age and Ageing

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Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium

Yang,

Do,

Zhu

et al. 2024

Int J Geriat Psychiatry

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ObjectivesPrior studies reported incidence of hypoactive and hyperactive subtypes of postoperative delirium, but did not consider cognitive symptoms of delirium which are highlighted in the DSM‐5 criteria for delirium. This study aims to address this gap in the literature by classifying cases of delirium according to their constellation of cognitive and motoric symptoms of delirium using a statistical technique called Latent Class Analysis (LCA).MethodsData were from five independent study cohorts (N = 1968) of patients who underwent elective spine, knee/hip, or elective gastrointestinal and thoracic procedures, between 2001 and 2017. Assessments of delirium symptoms were conducted using the long form of the Confusion Assessment Method (CAM) pre‐ and post‐surgery. Latent class analyses of CAM data from the first 2 days after surgery were conducted to determine subtypes of delirium based on patterns of cognitive and motoric symptoms of delirium. We also determined perioperative patient characteristics associated with each latent class of delirium and assessed whether the length of delirium for each of the patterns of delirium symptoms identified by the latent class analysis.ResultsThe latent class model from postoperative day 1 revealed three distinct patterns of delirium symptoms. One pattern of symptoms, denoted as the Hyperalert class, included patients whose predominant symptoms were being hyperalert or overly sensitive to environmental stimuli and having a low level of motor activity. Another pattern of symptoms, denoted as the Hypoalert class, included patients whose predominant symptom was being hypoalert (lethargic or drowsy). A third pattern of symptoms, denoted as the Cognitive Changes class, included patients who experienced new onset of disorganized thinking, memory impairment, and disorientation. Among 352 patients who met CAM criteria for delirium on postoperative day 1, 34% had symptoms that fit within the Hyperalert latent class, 39% had symptoms that fit within the Hypoalert latent class, and 27% had symptoms that fit within the Cognitive Changes latent class. Similar findings were found when latent class analysis was applied to those who met CAM criteria for delirium on postoperative day 2. Multinomial regression analyses revealed that ASA class, surgery type, and preoperative cognitive status as measured by the Telephone Interview for Cognitive Status (TICS) scores were associated with class membership. Length of delirium differed between the latent classes with the Cognitive Changes latent class having a longer duration compared to the other two classes.ConclusionsOlder elective surgery patients who did not have acute events or illnesses or a diagnosis of dementia prior to surgery displayed varying symptoms of delirium after surgery. Compared to prior studies that described hypoactive and hyperactive subtypes of delirium, we identified a novel subtype of delirium that reflects cognitive symptoms of delirium. The three subtypes of delirium reveal distinct patterns of delirium symptoms which provide insight into varying risks and care needs of patients with delirium, indicating the necessity of future research on reducing risk for cognitive symptoms of delirium.

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Diagnostische Strategien bei akut verwirrten Patienten

Eberhardt¹,

Topka²

2019

NeuroTransmitter

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Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study

Cited by 35 publications

References 25 publications

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium

Diagnostische Strategien bei akut verwirrten Patienten

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