Delirium in an adult acute hospital population: predictors, prevalence and detection

BMJ Open - Tập 3 Số 1 - Trang e001772 - 2013
Dan Ryan1, Niamh O’Regan1, Rónán Ó’Caoimh1, Josie Clare2, Marie O’Connor3, Maeve Leonard4, John McFarland5, Sheila Tighe6, Kathleen O’Sullivan7, Paula T. Trzepacz8,9, David Meagher4, Suzanne Timmons1
1Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork, Ireland
2Department of Medical Gerontology, Waterford Regional Hospital, Waterford, Ireland
3Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
4Department of Psychiatry, University of Limerick, Limerick, Ireland
5Clare Mental Health Services, Ennis Regional Hospital, Clare, Ireland
6Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
7School of Mathematical Sciences, University College Cork, Cork, Ireland
8Department of Neurosciences, Lilly Research Laboratories, Indianapolis, Indiana, USA
9Indiana University School of Medicine, Indianapolis, Indiana USA

Tóm tắt

BackgroundTo date, delirium prevalence and incidence in acute hospitals has been estimated from pooled findings of studies performed in distinct patient populations.ObjectiveTo determine delirium prevalence across an acute care facility.DesignA point prevalence study.SettingA large tertiary care, teaching hospital.Patients311 general hospital adult inpatients were assessed over a single day. Of those, 280 had full data collected within the study's time frame (90%).MeasurementsInitial 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.ResultsUsing 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 <50 years and 34.8% 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.ConclusionsOur 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.

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BMJ Open

Tập 3 Số 1

e001772

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