Frequency of delirium and subsyndromal delirium in an adult acute hospital population

Meagher, David; O’Regan, N; Ryan, Dan; Connolly, Warren; Boland, Eve; O’Caoimhe, R.; Clare, Josie; McFarland, John; Tighe, Sylvia Murphy; Leonard, Maeve; Adamis, Dimitrios; Trzepacz, Paula T.; Timmons, Suzanne

doi:10.1192/bjp.bp.113.139865

Cited by 94 publications

(62 citation statements)

References 40 publications

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“…The investigators estimated that there was a 23% prevalence and 13% incidence of SSD, and suggested that these percentages may be larger with more specific and frequent observations of mental status (4). However, depending on the criteria for defining SSD, the incidence does vary from one study to another (13). …”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Postoperative Subsyndromal Delirium

et al. 2015

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Background Whether postoperative subsyndromal delirium (SSD) is a separate syndrome from delirium and has clinical relevance is not well understood. Objectives We sought to investigate SSD in older surgical patients and to determine its prognostic significance. Methods We performed a prospective cohort study of patients aged ≥65 years of age scheduled for noncardiac surgery. Postoperative delirium was determined using the Confusion Assessment Method. SSD was defined as the presence of at least one out of a possible 10 symptoms of delirium, as defined by the Confusion Assessment Method, but not meeting criteria for delirium. Results The number of features of SSD on the first postoperative day was associated with the subsequent development of delirium on the next day, after controlling for other risk factors. Compared to a patient with no SSD features, a patient with one SSD feature was 1.07 times more likely to have delirium on the next day (95% CI 0.42, 2.53), 2 features – 3.32 times more likely (95% CI 1.42. 7.57), and ≥ 2 features - 8.37 times more likely (95% CI 4.98, 14.53). Furthermore, there was a significant relationship between the number of features of SSD and increased length of hospital stay, and worsened functional status at one month after surgery. Conclusions SSD is prevalent in at risk surgical patients and has prognostic significance. Only one symptom of SSD was sufficient to cause a significant increase in hospital length of stay and further decline in functional status. These results suggest that monitoring for SSD is indicated in at risk patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Postoperative Subsyndromal Delirium

et al. 2015

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“…Besides, initiating the therapeutic intervention as early as possible by detecting the early signs of delirium is essential for preventing its aggravation. With regard to the early stage of postoperative delirium, a concept exists called “subsyndromal delirium” [28-31], which is a frequent and clinically important condition that falls on a continuum between no symptoms and full delirium. The importance of starting the prophylactic intervention during the subsyndromal stage has also been reported.…”

Section: Discussionmentioning

confidence: 99%

Effects of Haloperidol on Delirium in Adult Patients: A Systematic Review and Meta-Analysis

et al. 2018

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Objective: The aim of this systematic review and meta-analysis was to investigate whether or not the use of haloperidol could reduce the incidence of delirium in adult patients. Subjects and Methods: PubMed, Embase, the Cochrane Library, Elsevier, Wiley, and Ovid were searched for randomized controlled trials and prospective interventional cohort studies that compared haloperidol with placebo for delirium prophylaxis or with second generation antipsychotics for delirium treatment. The primary end point was the incidence and severity of delirium. After reviewing 272 relevant articles, 10 studies with 1,861 patients were finally included (haloperidol vs. placebo in 8 studies [n = 1,734], and haloperidol vs. second-generation antipsychotics in 2 studies [n = 127]). Revman 5.3 was used for the data analysis. Results: Compared with placebo, a high dose of prophylactic haloperidol (≥5 mg/day) may help reduce the incidence of delirium in surgical patients (risk ratio 0.50, 95% CI 0.32, 0.79). There were no differences in the duration of delirium, QTc interval prolongation, extrapyramidal symptoms, intensive care unit stay, hospital stay, or mortality between the haloperidol and placebo groups. For delirium treatment, haloperidol exhibited similar effects as the second-generation antipsychotics. Conclusions: In this study, the limited available data revealed that prophylaxis haloperidol at a dose of ≥5 mg/day might help reduce delirium in adult surgical patients. Further outcome studies with larger sample sizes are required to confirm these findings.

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“…SSD could be defined by categorical elements, and is usually referred to as the presence of one or more symptoms in the Confusion Assessment Method (CAM) or the core symptoms of delirium in the Diagnostic and Statistical Manual of Mental Disorders (DSM) . It could also be defined quantitatively by an intermediate delirium score range; that is, less than full‐blown delirium, but more than no delirium on the 16‐item Revised Delirium Rating . SSD is also invariably associated with adverse outcomes including longer acute care hospital stay, higher post‐discharge mortality, and a lower cognitive and functional level at follow up than patients without delirium, but appears to have better outcomes than for those with delirium …”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of delirium and subsyndromal delirium in Chinese older adults

Yam

Shea

Chan³

et al. 2018

Geriatrics Gerontology Int

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Aim To study the prevalence and risk factors of delirium and subsyndromal delirium (SSD) in Chinese older adults with acute medical illnesses. Methods A prospective cohort study was carried out in acute general medical wards in a university‐affiliated hospital in Hong Kong. Patients were assessed by the confusion assessment method by geriatricians within 6 h after admission and classified into three mutually exclusive groups, namely delirium, SSD and those without both conditions. Predisposing factors and precipitating factors of delirium and SSD were retrieved from collateral information, clinical charts and electronic clinical records. Results A total of 575 patients with mean age of 80.8 years were recruited. A total of 73% of the patients did not have delirium, 15.8% of patients had delirium and 11.3% of patients had SSD. On multivariate analysis, patients with delirium or SSD were more likely to be current users of psychotropic medications, had hearing and visual impairment, had a major neurocognitive disorder as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and with a lower Barthel Index 20 points version than those without both conditions. Significant predisposing and precipitating factors of delirium included psychotropic medications, acute stroke and other causes of organic brain syndromes. Predisposing and precipitating factors of delirium and SSD were almost identical. Conclusions Delirium and SSD are common among Chinese older adults with acute medical illnesses, with a combined prevalence of delirium and SSD of 27%. Important precipitating and predisposing factors include psychotropic medications, acute ischemic stroke and other causes of organic brain syndromes. Geriatr Gerontol Int 2018; 18: 1625–1628.

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Frequency of delirium and subsyndromal delirium in an adult acute hospital population

Cited by 94 publications

References 40 publications

Prognostic Significance of Postoperative Subsyndromal Delirium

Prognostic Significance of Postoperative Subsyndromal Delirium

Effects of Haloperidol on Delirium in Adult Patients: A Systematic Review and Meta-Analysis

Prevalence and risk factors of delirium and subsyndromal delirium in Chinese older adults

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