Delirium in an adult acute hospital population: predictors, prevalence and detection
Top Cited Papers
Open Access
- 7 January 2013
- Vol. 3 (1), e001772
- https://doi.org/10.1136/bmjopen-2012-001772
Abstract
To date, delirium prevalence and incidence in acute hospitals has been estimated from pooled findings of studies performed in distinct patient populations. To determine delirium prevalence across an acute care facility. A point prevalence study. A large tertiary care, teaching hospital. 311 general hospital adult inpatients were assessed over a single day. Of those, 280 had full data collected within the study's time frame (90%). Initial screening for inattention was performed using the spatial span forwards and months backwards tests by junior medical staff, followed by two independent formal delirium assessments: first the Confusion Assessment Method (CAM) by trained geriatric medicine consultants and registrars, and, subsequently, the Delirium Rating Scale-Revised-98 (DRS-R98) by experienced psychiatrists. The diagnosis of delirium was ultimately made using DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria. Using DSM-IV criteria, 55 of 280 patients (19.6%) had delirium versus 17.6% using the CAM. Using the DRS-R98 total score for independent diagnosis, 20.7% had full delirium, and 8.6% had subsyndromal delirium. Prevalence was higher in older patients (4.7% if 80 years) and particularly in those with prior dementia (OR=15.33, p<0.001), even when adjusted for potential confounders. Although 50.9% of delirious patients had pre-existing dementia, it was poorly documented in the medical notes. Delirium symptoms detected by medical notes, nurse interview and patient reports did not overlap much, with inattention noted by professional staff, and acute change and sleep-wake disturbance noted by patients. Our point prevalence study confirms that delirium occurs in about 1/5 of general hospital inpatients and particularly in those with prior cognitive impairment. Recognition strategies may need to be tailored to the symptoms most noticed by the detector (patient, nurse or primary physician) if formal assessments are not available.This publication has 33 references indexed in Scilit:
- Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer DiseaseAnnals of Internal Medicine, 2012
- Dementia in the acute hospital: prospective cohort study of prevalence and mortalityThe British Journal of Psychiatry, 2009
- Impact of Delirium on Short-Term Mortality in Elderly Inpatients: A Prospective Cohort StudyPsychosomatics, 2009
- Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population*Critical Care Medicine, 2009
- Validation of the confusion assessment method in the palliative care settingPalliative Medicine, 2008
- Delirium detection in clinical practice and research: Critique of current tools and suggestions for future developmentJournal of Psychosomatic Research, 2008
- Risk Factors and Prediction of Postoperative Delirium in Elderly Hip‐Surgery Patients: Implementation and Validation of a Medical Risk Factor ModelJournal of the American Geriatrics Society, 2006
- DELIRIUM IN ELDERLY INDIVIDUALS WITH HIP FRACTURE: CAUSES, INCIDENCE, PREVALENCE, AND RISK FACTORSClinics, 2006
- Concurrent validity of two instruments (the Confusion Assessment Method and the Delirium Rating Scale) in the detection of delirium among older medical inpatientsAge and Ageing, 2005
- Acute Confusional States in Elderly Patients Treated for Femoral Neck FractureJournal of the American Geriatrics Society, 1988