Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1, 493 older emergency department patients: how many were sent home and what happened to them?. (12th February 2022)

• Record Type: Journal Article
• Authors: Lee, Jacques S; Tong, Tiffany; Chignell, Mark; Tierney, Mary C; Goldstein, Judah; Eagles, Debra; Perry, Jeffrey J; McRae, Andrew; Lang, Eddy; Hefferon, Darren; Rose, Louise; Kiss, Alex; Borgundvaag, Bjug; McLeod, Shelley; Melady, Don; Boucher, Valérie; Sirois, Marie-Josée; Émond, Marcel
• Is Part Of: Age and ageing. Volume 51:Number 2(2022)
• Publication Date: 2022-02-12
• Subjects: Emergency department -- delirium -- geriatrics -- recognition -- older people; Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afab214
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium. Objectives: To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes. Methods: Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls). Results: We enrolled 1, 493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2–6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4–66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2–72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort. Conclusion: Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.