Hyperactive delirium during emergency department stay: analysis of risk factors and association with short-term outcomes
Por:
Miró Ò., Osorio G., Alquézar-Arbé A., Aguiló S., Fernández C., Burillo G., Jacob J., Llorens P., Llauger L., Peláez González Á., Figuera Castro E.R., Juarez González R., Blanco Hoffman M.J., Fernandez Salgado F., Pablos Pizarro T., Berenguer Díez M.A., Truyol Más M., López-Laguna N., Garcia Acosta J., Fernandez Domato C., Diego Robledo F.J., Ezponda P., Martinez Lorenzo A., Ortega Liarte J.V., García Rupérez I., Borne Jerez S., Corugedo Ovies C., Gallardo Sánchez B.A., Del Castillo J.G.
Publicada:
21 oct 2023
Ahead of Print:
1 ene 2023
Resumen:
To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24-4.82), transfer to the ED observation unit (1.62, 1.23-2.15), chronic treatment with opiates (1.51, 1.09-2.09) and length of ED stay longer than 12 h (1.41, 1.02-1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37-0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83-2.78), need for hospitalization 25.6% and 25% (1.09, 0.83-1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24-4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80-2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82-2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.
Filiaciones:
Miró Ò.:
Emergency Department, Hospital Clínic, IDIBAPS, Catalonia, Barcelona, Spain
Department of Medicine, Faculty of Medicine, University of Barcelona, Catalonia, Barcelona, Spain
Osorio G.:
Emergency Department, Hospital Clínic, IDIBAPS, Catalonia, Barcelona, Spain
Alquézar-Arbé A.:
Emergency Department, Hospital de La Santa Creu I Sant Pau, Catalonia, Barcelona, Spain
Aguiló S.:
Emergency Department, Hospital Clínic, IDIBAPS, Catalonia, Barcelona, Spain
Fernández C.:
Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain
Burillo G.:
Emergency Department, Hospital Universitario de Canarias, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Tenerife, Spain
Jacob J.:
Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Barcelona, Spain
Llorens P.:
Emergency Department, Hospital Universitario Dr. Balmis, Alicante, Spain
Llauger L.:
Emergency Department, Hospital Universitari de Vic, Catalonia, Barcelona, Spain
Peláez González Á.:
Emergency Department, Hospital del Nalón, Asturias, Langreo, Spain
Figuera Castro E.R.:
Emergency Department, Hospital Altagracia, Ciudad Real, Manzanares, Spain
Juarez González R.:
Emergency Department, Hospital Nuestra Señora del Prado de Talavera de La Reina, Toledo, Spain
Blanco Hoffman M.J.:
Emergency Department, Hospital Universitario Vinalopó, Alicante, Elche, Spain
Fernandez Salgado F.:
Emergency Department, Hospital de Móstoles, Madrid, Spain
Pablos Pizarro T.:
Emergency Department, Hospital Virgen del Rocio, Seville, Spain
Berenguer Díez M.A.:
Emergency Department, Hospital General Universitario Dr. Peset, Valencia, Spain
Truyol Más M.:
Emergency Department, Hospital Universitario Son Espases, Palma, Spain
López-Laguna N.:
Emergency Department, Clinica Universitaria Navarra de Madrid, Madrid, Spain
Garcia Acosta J.:
Emergency Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
Fernandez Domato C.:
Emergency Department, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain
Diego Robledo F.J.:
Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
Ezponda P.:
Emergency Department, Hospital de Zumárraga, Guipúzcoa, Spain
Martinez Lorenzo A.:
Emergency Department, Hospital Virxe da Xunqueira, Cee, A Coruña, Spain
Ortega Liarte J.V.:
Emergency Department, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, Spain
García Rupérez I.:
Emergency Department, Hospital Universitario Río Ortega, Valladolid, Spain
Borne Jerez S.:
Emergency Department, Hospital Juan Ramón Jiménez, Huelva, Spain
Corugedo Ovies C.:
Emergency Department, Hospital Central de Asturias, Oviedo, Spain
Gallardo Sánchez B.A.:
Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain
Del Castillo J.G.:
Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain
hybrid, All Open Access; Hybrid Gold
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