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

Creator:

Ryan, Daniel James; O'Regan, Niamh; Ó Caoimh, Ronán; Clare, Josie; O'Connor, Marie; Leonard, Maeve; McFarland, John; Tighe, Sheila; O'Sullivan, Kathleen; Trzepacz, Paula T; Meagher, David; Timmons, Suzanne;

Institution: BMJ Publishing Group
Subject Keywords: delirium; neuropsychiatric syndrome; medical and nursing staff;
Region:
Description:

Background: To date, delirium prevalence and
incidence in acute hospitals has been estimated from
pooled findings of studies performed in distinct patient
populations.
Objective: To determine delirium prevalence across
an acute care facility.
Design: A point prevalence study.
Setting: A large tertiary care, teaching hospital.
Patients: 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%).
Measurements: 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.
Results: 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 <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.
Conclusions: 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.

Suggested citation:

Ryan, Daniel James; O&#039;Regan, Niamh; Ó Caoimh, Ronán; Clare, Josie; O&#039;Connor, Marie; Leonard, Maeve; McFarland, John; Tighe, Sheila; O&#039;Sullivan, Kathleen; Trzepacz, Paula T; Meagher, David; Timmons, Suzanne; . () Delirium in an adult acute hospital population: predictors, prevalence and detection [Online]. Available from: http://www.thehealthwell.info/node/826013 [Accessed: 17th July 2018].

  

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