Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study

Raso, Júlia; Santos, Lincoln Marques Cavalcante; Reis, Débora Alves; Frangiotti, Marília Amaral Costa; Zanetti, Ariane Cristina Barboza; Capucho, Helaine Carneiro; Herdeiro, María Teresa; Roque, Fátima; Pereira, Leonardo Régis Leira; Varallo, Fabiana Rossi

doi:10.1007/s11096-022-01378-8

Cited by 5 publications

(3 citation statements)

References 36 publications

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“…Patients who had a history of addiction to alcohol, tobacco and/or illicit drugs and/or had mental and behavioral disorders due to dependence or withdrawal crisis from these substances were also not enrolled. 15 The recruitment of eligible hospitalizations and suspected potential delirium was also carried out according to the strategies developed by Raso et al: 15 a. In-hospital prescriptions of antipsychotic medicines: screening occurred with the identification of at least one in-hospital prescription of typical or atypical antipsychotic medicine, both for administration of time and/or for use when necessary. All dosage forms of haloperidol, levomepromazine, olanzapine, quetiapine, and risperidone available in the emergency department were considered.…”

Section: Study Populationmentioning

confidence: 99%

Performance de trigger tools para triagem de potencial delirium hiperativo em pessoas idosas hospitalizados em departamento de emergência brasileiro

Raso¹,

Santos²,

Reis³

et al. 2022

Rev Bras Farm Hosp Serv Saude

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Objetivo: Avaliar o desempenho de termos trigger tools na detecção de internações de pacientes idosos com potencial delirium hiperativo em uma unidade de emergência. Métodos: Um estudo transversal foi realizado com todos os pacientes com idade ≥ 60 anos internados em unidade de emergência de um hospital universitário brasileiro em 2018. A triagem de potencial delirium hiperativo foi feita com as seguintes trigger tools: prescrição instra-hospitalar de antipsicóticos, códigos do 10° Código Internacional de Doenças (CID-10) proposto pela 5ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais, e palavras-chave relacionadas com delirium hiperativo registradas em prontuários médicos por profissionais da saúde. O valor preditivo positivo (VPP) foi calculado para avaliar a performance de cada trigger tool. Resultados: A maioria das hospitalizações (192/286) foi triada por pelo menos um dos trigger tools, das quais 49.2% mostrou potencial delirium hiperativo. O trigger tool de CID-10 mostrou uma melhor performance (VPP=0.71), no entanto, essa estratégia subestimou a detecção de casos potenciais [2.6% (5/193)]. A despeito da performance de das prescrições intra-hospitalares de antipsicóticos e palavras-chave ter sido mais baixa (VPP=0.69, e VPP=0.48, respectivamente), a prevalência de potencial delirium hiperativo identificado foi maior com estes métodos [30.0% (58/193); e 47.1% (91/193); respectivamente]. Conclusão: O uso de trigger tools detectou uma a cada três hospitalizações de idosos com potencial delirium hiperativo. A combinação das estratégias pode contribuir para o reconhecimento da síndrome em unidade de emergência. Os dados sugerem que a triagem pode ser realizada por farmacêuticos em associação com abordagens multicomponentes e interprofissionais para melhorar a segurança do paciente.

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Section: Study Populationmentioning

confidence: 99%

Performance de trigger tools para triagem de potencial delirium hiperativo em pessoas idosas hospitalizados em departamento de emergência brasileiro

Raso¹,

Santos²,

Reis³

et al. 2022

Rev Bras Farm Hosp Serv Saude

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“…The multifactorial nature is due to the concurrence of predisposing factors and precipitating factors. Age, cognitive deficit, drugs, sensory deficits, comorbidity and dehydration are some predisposing factors and urinary and respiratory infections and the administration or deprivation of psychotropic drugs and the administration of anticholinergic drugs as precipitating factors, as well as harsh hospital techniques ( 2 ). The syndrome has significant consequences for both the patient and the healthcare system, including higher rates of functional dependency and longer hospital stays, as well as increased risk of falling, institutionalization, morbidity, and mortality ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…The Manchester Triage System (MTS) is a systematized protocol to determine the patient’s severity as well as associated risks and needs, according to the flow chart, thus optimizing waiting time and resource use according to care needs ( 11 ). This process aims to provide a rapid and dynamic assessment ( 2 , 12 ). Accurate and early detection of delirium may provide opportunities for identifying high-risk patients, potentially preventing or minimizing cases of delirium in the ED ( 9 , 10 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

The 4AT scale for rapid detection of delirium in emergency department triage

Soler-Sanchis,

Martínez-Arnau,

Sánchez-Frutos

et al. 2024

Front. Med.

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AimsTo assess the diagnostic accuracy and time impact of the 4AT scale in emergency department triage.MethodsA Prospective diagnostic accuracy study was carried out. People aged ≥65 years presenting to the emergency department from 1 November 2021 to 30 June 2022 were included. Nurses opportunistically screened eligible patients using the 4AT scale during triage according to the Manchester Triage System Francesc de Borja Hospital emergency department, Gandía (Spain). Accuracy was compared with medical diagnosis of delirium. Time (seconds) spent in triage with and without screening was assessed.ResultsThe study included 370 patients (55.1% men, mean age 81.8 years), of whom 58.4% (n = 216) were screened. A final diagnosis of delirium was made in 41.4% of those screened. The most frequently used presentational flow charts and discriminators were ‘behaving strangely’ (15%) and ‘rapid onset’ (33.3%). The highest accuracy was obtained for a score of 3 points or more (sensitivity 85.1%; specificity 66.9%; positive predictive value 52.8%; negative predictive value 71.7%). No significant differences were found in the time spent in triage according to the performance of screening.ConclusionA score of 3 points or more on the 4AT scale enables rapid detection of delirium in emergency department triage, without consuming more time than conventional triage.

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Overview of this issue: “clinical pharmacy impacting mental health delivery and outcomes”

Hahn,

Stuhec,

da Costa

2023

Int J Clin Pharm

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Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study

Cited by 5 publications

References 36 publications

Performance de trigger tools para triagem de potencial delirium hiperativo em pessoas idosas hospitalizados em departamento de emergência brasileiro

Performance de trigger tools para triagem de potencial delirium hiperativo em pessoas idosas hospitalizados em departamento de emergência brasileiro

The 4AT scale for rapid detection of delirium in emergency department triage

Overview of this issue: “clinical pharmacy impacting mental health delivery and outcomes”

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