Low-Dose Trazodone for Delirium in Patients with Cancer Who Received Specialist Palliative Care: A Multicenter Prospective Study

Maeda, Isseki; Inoue, Shin‐ichiro; Uemura, Keiichi; Tanimukai, Hitoshi; Hatano, Yutaka; Yokomichi, Naosuke; Amano, Koji; Tagami, Keita; Yoshiuchi, Kazuhiro; Ogawa, Asao; Iwase, Satoru

doi:10.1089/jpm.2020.0610

Cited by 14 publications

(14 citation statements)

References 16 publications

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“…A retrospective medical chart review showed similar results for trazodone and quetiapine in terms of improvement of delirium symptoms [ 36 ]. In a prospective study in palliative cancer patients, low-dose trazodone proved generally safe and reduced delirium severity [ 37 ].…”

Section: Pharmacological Therapymentioning

confidence: 99%

Delirium in geriatric patients

Iglseder

Frühwald²,

Jagsch

2022

Wien Med Wochenschr

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SummaryDelirium is the most common acute disorder of cognitive function in older patients. Delirium is life threatening, often under-recognized, serious, and costly. The causes are multifactorial, with old age and neurocognitive disorders as the main risk factors. Etiologies are various and multifactorial, and often related to acute medical illness, adverse drug reactions, or medical complications. To date, diagnosis is clinically based, depending on the presence or absence of certain features. In view of the multifactorial etiology, multicomponent approaches seem most promising for facing patients’ needs. Pharmacological intervention, neither for prevention nor for treatment, has been proven effective unanimously. This article reviews the current clinical practice for delirium in geriatric patients, including etiology, pathophysiology, diagnosis, prognosis, treatment, prevention, and outcomes.

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Section: Pharmacological Therapymentioning

confidence: 99%

Delirium in geriatric patients

Iglseder

Frühwald²,

Jagsch

2022

Wien Med Wochenschr

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“…The present study is a secondary analysis of Phase-R, a multicenter and prospective observational study (Okuyama et al, 2019;Maeda et al, 2020Maeda et al, , 2021Matsuda et al, 2020;Uchida et al, 2020). Data were collected at 14 palliative care units certified by the Hospice Palliative Care Japan and 9 psycho-oncology settings of tertiary cancer care hospitals or university hospitals across Japan from September 2015 to May 2016.…”

Section: Phase-r Studymentioning

confidence: 99%

A decision tree prediction model for a short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions: A secondary analysis of a multicenter and prospective observational study (Phase-R)

Kurisu

Inada

Maeda³

et al. 2021

Pall Supp Care

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Objective There is no widely used prognostic model for delirium in patients with advanced cancer. The present study aimed to develop a decision tree prediction model for a short-term outcome. Method This is a secondary analysis of a multicenter and prospective observational study conducted at 9 psycho-oncology consultation services and 14 inpatient palliative care units in Japan. We used records of patients with advanced cancer receiving pharmacological interventions with a baseline Delirium Rating Scale Revised-98 (DRS-R98) severity score of ≥10. A DRS-R98 severity score of <10 on day 3 was defined as the study outcome. The dataset was randomly split into the training and test dataset. A decision tree model was developed using the training dataset and potential predictors. The area under the curve (AUC) of the receiver operating characteristic curve was measured both in 5-fold cross-validation and in the independent test dataset. Finally, the model was visualized using the whole dataset. Results Altogether, 668 records were included, of which 141 had a DRS-R98 severity score of <10 on day 3. The model achieved an average AUC of 0.698 in 5-fold cross-validation and 0.718 (95% confidence interval, 0.627–0.810) in the test dataset. The baseline DRS-R98 severity score (cutoff of 15), hypoxia, and dehydration were the important predictors, in this order. Significance of results We developed an easy-to-use prediction model for the short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions. The baseline severity of delirium and precipitating factors of delirium were important for prediction.

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“…Patients satisfying exclusion criterion (1) were excluded due to a lack of data, while those meeting criteria (2) or (3) were dropped since they might have already been delirious at admission. Medication for delirium was defined as any antipsychotics, mianserin, trazodone, or yokukansan which have all been generally prescribed for delirium (13,(25)(26)(27). Delirious at admission was defined as already exhibiting "delirium with event" which was the main outcome of this study (described below), within 3 h after admission.…”

Section: Setting and Study Populationmentioning

confidence: 99%

Hospital Admission to a Window-Side Bed Does Not Prevent Delirium: A Retrospective Cohort Study of Older Medical Inpatients in General Wards

et al. 2021

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Background: Delirium in older inpatients is a serious problem. The presence of a window in the intensive care unit has been reported to improve delirium. However, no study has investigated whether window-side bed placement is also effective for delirium prevention in a general ward.Objectives: This study aims to clarify the association between admission to a window-side bed and delirium development in older patients in a general ward.Design: This research is designed as a retrospective cohort study of older patients admitted to the internal medicine departments of Shinshu University Hospital, Japan.Participants: The inclusion criteria were the following: (1) admitted to hospital internal medicine departments between April 2009 and December 2018, (2) older than 75 years, (3) admitted to a multi-patient room in a general ward, and (4) unplanned admission. The number of eligible patients was 1,556.Exposure: This study is a comparison of 495 patients assigned to a window-side bed (window group) with 1,061 patients assigned to a non-window-side bed (non-window group). When patients were transferred to the other type bed after admission, observation was censored.Main Measures: The main outcome of interest was “delirium with event” (e.g., the use of medication or physical restraint for delirium) within 14 days after admission as surveyed by medical chart review in a blinded manner.Key Results: The patients had a median age of 80 years and 38.1% were female. The main outcome was recorded in 36 patients in the window group (10.7 per thousand person-days) and 84 in the non-window group (11.7 per thousand person-days). Log-rank testing showed no significant difference between the groups (p = 0.78). Multivariate analysis with Cox regression modeling also revealed no significant association for the window group with main outcome development (adjusted hazard ratio 0.90, 95% confidence interval of 0.61–1.34).Conclusions: Admission to a window-side bed did not prevent delirium development in older patients admitted to a general ward.

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Low-Dose Trazodone for Delirium in Patients with Cancer Who Received Specialist Palliative Care: A Multicenter Prospective Study

Cited by 14 publications

References 16 publications

Delirium in geriatric patients

Delirium in geriatric patients

A decision tree prediction model for a short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions: A secondary analysis of a multicenter and prospective observational study (Phase-R)

Hospital Admission to a Window-Side Bed Does Not Prevent Delirium: A Retrospective Cohort Study of Older Medical Inpatients in General Wards

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