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Lai YH, Lin CJ, Su IC, Huang SW, Hsiao CC, Jao YL, Chen PY, Traynor V, Lee CY, Chen TJ, Ho MH, Chiu HY. Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury. J Acad Consult Liaison Psychiatry 2025:S2667-2960(24)00140-X. [PMID: 39761830 DOI: 10.1016/j.jaclp.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 11/24/2024] [Accepted: 12/30/2024] [Indexed: 02/01/2025]
Abstract
BACKGROUND Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population. OBJECTIVE To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury. METHODS This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium. RESULTS A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (P = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively. CONCLUSION The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.
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Affiliation(s)
- Yun-Hsuan Lai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Jou Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - I-Chang Su
- Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Wen Huang
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chi Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Ying-Ling Jao
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Victoria Traynor
- School of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, Australia; Warrigal, Albion Park Rail, NSW, Australia
| | - Chuan-Ya Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ting-Jhen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
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Sun G, Torjman MC, Min KJ. A comprehensive analysis of in-hospital adverse events after scopolamine administration: insights from a retrospective cohort study using a large nationwide inpatient database. BMC Anesthesiol 2024; 24:438. [PMID: 39604832 PMCID: PMC11604008 DOI: 10.1186/s12871-024-02824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/18/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Scopolamine is a widely used antiemetic in anesthetic practice, particularly for postoperative and post-discharge nausea and vomiting. Despite its frequent usage and recognized efficacy, concerns have emerged regarding the potential for increased side effects, particularly in elderly patients. Further research is needed to assess safety and determine age thresholds for adverse events. This study hypothesizes associations between perioperative scopolamine use, worse clinical outcomes, increased pneumonia, delirium, urinary retention, and readmissions. METHODS A large, retrospective cohort study was performed using the TriNetX Analytics Network database on patients undergoing major surgical procedures between Jan 1, 2009, and March 21, 2018, to examine the impact of perioperative scopolamine use on in-hospital adverse events. Patients were divided into age groups and compared to a control group. The primary outcomes assessed were delirium, pneumonia, in-hospital death, new antipsychotic use, readmission, and new onset urinary retention within 7 days post-surgery. 1:1 propensity score matching was performed to reduce bias. Relative risk and risk differences with 95% confidence intervals were estimated. RESULTS After 1:1 propensity score matching, we identified a total of 403,816 (201,908 pairs) perioperative scopolamine users and nonusers. The cohorts of 20-29, 30-39, 40-49, 50-59, 60-69, and 70 + contained 22,910 (11,455 pairs), 44,170 (22,085 pairs), 58,590 (29,295 pairs), 71,660 (35,830 pairs), 88,386 (44,193 pairs), and 118,100 (59,050 pairs) patients respectively. Across older age cohorts, after propensity score matching, perioperative scopolamine recipients had significantly increased relative risk and risk difference of delirium, pneumonia, in-hospital mortality, new antipsychotic use, readmission, and new-onset urinary retention. CONCLUSIONS In this cohort study, perioperative scopolamine usage was associated with a significantly increased risk of in-hospital adverse events, both within the 70 + age cohort and among the 20-29, 30-39, 40-49, 50-59, and 60-69 age cohorts after major surgery. These findings highlight the need for careful assessment of scopolamine's risks and benefits, especially for patients aged 40 and older. Scopolamine may be most suited for post-discharge nausea and vomiting in ambulatory patients and clinicians should reassess its standard use for postoperative nausea and vomiting, favoring shorter-acting agents with fewer side effects.
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Affiliation(s)
- George Sun
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University, 111 S 11th St Gibbon Building, Philadelphia, PA, 8330, 19107, USA
| | - Marc C Torjman
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University, 111 S 11th St Gibbon Building, Philadelphia, PA, 8330, 19107, USA
| | - Kevin J Min
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University, 111 S 11th St Gibbon Building, Philadelphia, PA, 8330, 19107, USA.
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Chow SKY, Chan SC. Appraising the Factors Associated with Delirium Care Behaviours and Barriers to Their Assessment Among Clinical Nurses: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1582. [PMID: 39767424 PMCID: PMC11675558 DOI: 10.3390/ijerph21121582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 11/20/2024] [Accepted: 11/26/2024] [Indexed: 01/11/2025]
Abstract
Delirium can occur at any age, although the incidence is higher in older patients and after surgery. Although delirium is an acute, potentially reversible, cognitive disorder, there is evidence that it is associated with increased healthcare costs and imposes a significant burden on patients, families, hospitals, and public resources. The aim of this study was to investigate and assess the knowledge, behaviours, and factors influencing assessments of delirium by hospital nurses so as to predict the factors associated with their current delirium management behaviours. A cross-sectional survey was conducted among 342 nurses in different hospitals in Macau. The questionnaires included items on the respondents' demographic information, knowledge of delirium care, nursing behaviours, and factors influencing nurses' assessment of delirium patients in their daily practice. The descriptive statistics showed that nurses were found to have a moderate level of knowledge about the management of delirium. The repeated measures ANOVA revealed that patient factors were the most significant, outweighing individual and organizational factors as barriers to assessing patients with delirium. The Pearson's correlation showed a moderate positive correlation between delirium care knowledge and delirium care behaviour (r = 0.339). With regard to factors influencing delirium care behaviours, multiple linear regression models showed that the significant predictors were years of work experience (β = 0.206, 95% CI: 1.125-3.158), the duration of delirium care courses (β = 0.103, 95% CI: 0.118-3.339), the knowledge of delirium care (β = 0.264, 95% CI: 0.474-1.019), and personal factors influencing nurses' delirium assessments (β = -0.239, 95% CI: -1.031--0.432). To enhance delirium management and achieve the optimal care of patients with delirium, formal education and training are crucial. Organizations should develop structured protocols and workflows that empower nurses. By integrating organizational strategies with individual efforts, clinical practices can be improved, resulting in optimal delirium care for patients.
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Affiliation(s)
- Susan Ka Yee Chow
- Discipline of Nursing & Healthcare, Hong Kong Nang Yan College of Higher Education, Hong Kong SAR, China
- Faculty of Medicine, Macau University of Science and Technology, Macao SAR, China
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Salhotra R, Bose A, Srivastava S, Mohta M, Pandarinathan K, Rautela RS. Reliability and Validity of Hindi Version of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) for Diagnosis of Delirium: A Cohort Study. Indian J Crit Care Med 2024; 28:958-962. [PMID: 39411299 PMCID: PMC11471980 DOI: 10.5005/jp-journals-10071-24809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 08/24/2024] [Indexed: 10/19/2024] Open
Abstract
Background The confusion assessment method for the intensive care unit (CAM-ICU) is a bedside tool to diagnose delirium in critically ill patients. This study aims to determine the reliability and validity of the Hindi version of CAM-ICU against the Diagnostic and Statistical Manual (DSM), fourth edition text revision (DSM-IV-TR), and DSM, fifth edition (DSM-5) criteria for diagnosis of delirium. Methods Seventy-five Hindi-speaking consenting patients ≥18-year-old with Richmond Agitation Sedation Scale ≥-3 and an anticipated ICU stay > 48 hours were included. Patients with known severe mental illnesses, visual/hearing loss, neurological injury, burns, drug overdose, and Glasgow Coma Scale <9 at the time of screening were excluded. After 48 hours of ICU stay and ensuring at least 2 hours of sedative interruption, within a 4-hour period, two examiners independently assessed delirium using the Hindi version of the scale and an experienced psychiatrist assessed the patients independently and applied the DSM-IV-TR and DSM-5 criteria for diagnosing delirium. Time taken for CAM-ICU assessment, inter-observer reliability, sensitivity, specificity, and positive and negative predictive values were calculated. Results The Cohen's κ value was 0.944 (p < 0.001). The Cronbach's α for observer 1 and observer 2 was 0.961 and 0.968, respectively. The sensitivity and negative predictive value of the tool was 100% with both DSM-IV-TR and DSM-5. The specificity was 90.2% and 92% and the positive predictive value was 82.8 and 86.2% with DSM-IV-TR and DSM-5, respectively. Conclusions The Hindi version of CAM-ICU is a reliable and valid tool for the diagnosis of delirium in an ICU setting. Trial registration The study was registered with the Clinical Trials Registry, India (CTRI) as per the research guidelines laid down by the Indian Council of Medical Research before enrolling the participants. (CTRI number- CTRI/2021/01/030471). The registration date was 14th January 2021. URL of registry is http://ctri.nic.in. Highlights Delirium in the ICU is often undiagnosed due to unfamiliarity, lack of understanding of symptoms, non-availability of psychiatric consultation, and validated diagnostic tools in the native language of the patient. This study aims to find the reliability and validity of the Hindi version of CAM-ICU. How to cite this article Salhotra R, Bose A, Srivastava S, Mohta M, Pandarinathan K, Rautela RS. Reliability and Validity of Hindi Version of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) for Diagnosis of Delirium: A Cohort Study. Indian J Crit Care Med 2024;28(10):958-962.
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Affiliation(s)
- Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Abhirup Bose
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Shruti Srivastava
- Department of Psychiatry, Guru Teg Bahadur Hospital, New Delhi, India
| | - Medha Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Karthik Pandarinathan
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rajesh Singh Rautela
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Tekletsadik YA, Workineh SA, Gesso AS, Hirbo HS. Postoperative delirium among elderly elective orthopedic patients in Addis Ababa Ethiopia: a multicentere longitudinal study. BMC Anesthesiol 2024; 24:343. [PMID: 39342127 PMCID: PMC11438145 DOI: 10.1186/s12871-024-02729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Delirium is a neurocognitive disorder characterized by an acute and relatively rapid decline in cognition, disturbance of consciousness, reduced ability to focus, and shift of attention. It mainly affects elderly patients with an incidence of about 8-23% after an operation. It frequently occurs between 24-hrs and 5 days after surgery. It results in serious medical management problems. Hence, identifying the incidence and associated factors may help prevent and manage its sequel in the elderly. OBJECTIVE Assessment of the incidence and associated factors of postoperative delirium(POD) among elderly elective orthopedic surgical patients in Addis Ababa public hospitals, Ethiopia, 2024. METHODS A multi-centered longitudinal study was conducted on 220 elderly (age ≥ 65 years) patients in four selected public hospitals of the study area from February 2024 to May 2024, and a systematic sampling technique was used to select the study units. Data was collected through chart review and interviews of patients, and postoperative delirium was assessed using the confusion assessment method (CAM). Both bivariable and multivariable logistic regression models were used for statistical analysis. The strength of association was determined with an adjusted odds ratio (AOR) with a 95% confidence interval(CI) at a p-value of < 0.05. RESULTS A total of 220 patients were studied, and the incidence of POD among elderly elective orthopedic surgical patients was 33.7%. Age 65-75(AOR = 0.47, 95%CI (0.226-0.97)), Induction using ketamine (AOR = 1.32, 95%CI(1.109-3.87), p = 0.003)), perioperative opioid use (AOR = 2.20, 95%CI(1.073 4.5313)), intraoperative anticholinergic use(AOR = 2.24,95%CI(1.831-4.235)), recent hospitalization history (AOR = 2.24,95%CI(1.202-4.206)), and transfusion (AOR = 2.83,95%CI(1.295-6.193)) were significantly associated with POD (p < 0.05). CONCLUSION AND RECOMMENDATIONS The incidence of POD in the study area was high (33.7%); advanced age, hospitalization history, Anesthesia induction by Ketamine, perioperative anticholinergic uses, opioid use, and blood transfusion use were associated factors for postoperative delirium. We recommend giving due attention to elderly patients with advanced age, history of hospitalization, perioperative Ketamie use, perioperative anticholinergic uses, opioid use, and blood transfusion use undergoing elderly elective orthopedic surgery.
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Affiliation(s)
- Y A Tekletsadik
- Wachemo University College of Health and Medical Sciences, Hosanna, Ethiopia
| | - S A Workineh
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - A S Gesso
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
| | - H S Hirbo
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
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Fang Y, Dou A, Shen Y, Li T, Liu H, Cui Y, Xie K. Association of triglyceride-glucose index and delirium in patients with sepsis: a retrospective study. Lipids Health Dis 2024; 23:227. [PMID: 39054513 PMCID: PMC11271053 DOI: 10.1186/s12944-024-02213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE It is well known that glucose and lipid metabolism disorders and insulin resistance are common in sepsis, which affect the occurrence and prognosis of multiple organ dysfunction in septic patients. Previous study reported the predictive value of triglyceride-glucose index (TyG), a clinical indicator for insulin resistance, in postoperative delirium patients. However, it remains unclear whether the TyG index is a novel predictive biomarker for sepsis-associated delirium. The aim of this study is to explore the relationship between TyG index and the risk of delirium in patients with sepsis. METHODS Adult septic patients were identified from the MIMIC-IV database and divided into four groups based on the mean value of TyG. The primary outcome was the incidence of delirium. The association between TyG and the risk of developing delirium was evaluated by restricted cubic spline (RCS), multivariate logistic regression and subgroup analysis. Propensity Score Matching (PSM) method was used to balance the baseline data. RESULTS A total of 3,331 septic patients were included in the analysis, and further divided into four groups: Q1 (TyG ≤ 8.67), Q2 (8.67 < TyG ≤ 9.08), Q3 (9.08 < TyG ≤ 9.61), and Q4 (TyG > 9.61). The RCS curves demonstrated a non-linear positive relationship between TyG index and the risk of developing delirium, and an optimal cut-of value 9.09 was recommended. After balancing the baseline information by PSM, patients in the TyG > 9.09 group had a significant higher incidence of delirium compared with those in the TyG ≤ 9.09 group. In logistic regression analysis, TyG > 9.09 was significantly associated with lower risk of developing delirium in both original cohort (OR 1.54-1.78, all P < 0.001) and the PSM cohort (OR 1.41-1.48, all P < 0.001). No association was found between the TyG index and mortality (all P > 0.05). In subgroup analysis, our findings were consistent (all OR > 1 in all subgroups). CONCLUSION Our study demonstrated an independent association between TyG index and increased risk of delirium in septic patients, indicating that TyG index can serve as a biomarker for delirium in sepsis.
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Affiliation(s)
- Yipeng Fang
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China
| | - Aizhen Dou
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China
| | - Yuehao Shen
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China
| | - Tianyu Li
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China
| | - Haiying Liu
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China
| | - Yan Cui
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China.
- Department of Pathogen Biology, School of Basic Medical Sciences, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China.
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, 154th Anshan Road, Tianjin, 300052, China.
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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Sabbe K, van der Mast R, Dilles T, Van Rompaey B. Validation of the Delirium Observation Screening Scale in long-term care facilities in Flanders. Geriatr Gerontol Int 2024; 24:619-625. [PMID: 38624223 DOI: 10.1111/ggi.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
AIM The aim of this study was to validate the Delirium Observation Screening Scale (DOSS) in a population of long-term care facility (LTCF) residents in Flanders. Currently there is no validated screening tool for delirium available for the population in this setting in Flanders. METHODS A multisite, cross-sectional study was conducted in six LTCFs. A total of 338 residents aged 65 years and older were included. Sociodemographic and clinical data, including data from the Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM) and DOSS, were obtained by three trained nurse researchers. For the DOSS, internal consistency was determined, and inter-rater reliability was calculated. To validate the DOSS, the sensitivity, specificity, and positive and negative predictive value of the DOSS relative to the CAM were determined through receiver operating characteristic analysis. This article adheres to the Strengthening the Reporting of Observational Studies (STROBE) checklist for observational research. RESULTS For 338 residents, delirium assessments were completed during an early or late shift. The prevalence of delirium was 14.2% as measured with the DOSS. The reliability (α) for the CAM and DOSS was assessed, as was the inter-rater reliability (κ) and the area under the curve. The sensitivity and specificity for a cut-off value of 3 on the DOSS by Youden's index were very high, as was the negative predictive value. The positive predictive value was good. CONCLUSIONS This study showed that the DOSS is a reliable and valid instrument to screen for delirium in LTCF residents in Flanders. Geriatr Gerontol Int 2024; 24: 619-625.
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Affiliation(s)
- Kelly Sabbe
- Faculty of Medicine and Health Sciences, Department of Nursing and Midwifery, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
- Health Service Research, Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Roos van der Mast
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
- Leiden University Medical Centre, University of Leiden, Leiden, The Netherlands
| | - Tinne Dilles
- Faculty of Medicine and Health Sciences, Department of Nursing and Midwifery, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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Ye F, Ho MH, Lee JJ. Prevalence of post-stroke delirium in acute settings: A systematic review and meta-analysis. Int J Nurs Stud 2024; 154:104750. [PMID: 38552472 DOI: 10.1016/j.ijnurstu.2024.104750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Although post-stroke delirium is a frequent complication in acute settings and has significant long-lasting implications for patients, the prevalence of post-stroke delirium diagnosed according to gold-standard criteria remains uncertain. This highlights the importance of updating the current evidence. OBJECTIVE This review aims to provide a precise estimation of the prevalence of delirium in acute post-stroke settings and to explore potential differences in the reported prevalence according to the characteristics of the study and stroke survivors. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Post-stroke survivors with delirium in acute settings. DATA SOURCES Five English and two Chinese language databases from inception to June 2023, and the reference lists of published reviews. METHODS Studies reporting the prevalence of post-stroke delirium according to the Diagnostic and Statistical Manual of Mental Disorders criteria with the description of assessment method in the absence of interventions for delirium were eligible. Two reviewers independently screened searched records and extracted data from eligible studies. A meta-analysis was conducted using a random-effects model to evaluate the prevalence of post-stroke delirium, and predefined subgroup analyses, sensitivity analyses, and mixed-effects meta-regression were conducted to explore the contribution of heterogeneity. RESULTS Twenty-nine eligible studies involving 8839 survivors were included. In acute settings, the overall weighted prevalence of post-stroke delirium was 25 % (95 % CI, 20-30; I2, 95 %). Subgroup analyses revealed age-dependent variations in delirium prevalence, with rates of 20 %, 25 %, and 34 % for ages 60-64, 65-74, and 75-79, respectively. Delirium prevalence varied by assessment duration (7 days: 31 %, >7 days: 24 %, <7 days: 20 %). Initial screening significantly reduced reported prevalence to 15 %, compared with 30 % when no initial screening was conducted. Delirium prevalence was lower when nurses were involved in assessments (13 % vs. 29 %). No significant effects were detected for economic status, publication year, female percentage, onset-to-admission time, stroke type, and assessment frequency. Meta-regression analysis revealed that higher delirium prevalence was associated with increased survivors' age (β = 0.051; 95 % CI, -0.0002 to 0.103; P = 0.05; R2 = 13.36 %). CONCLUSION A high prevalence of post-stroke delirium was observed in acute settings. Nurses are required to integrate and coordinate the prevention, early detection, and management of delirium following stroke into their nursing practice, particularly for older stroke survivors. The findings necessitate the need for incorporating specialized training within nursing education to identify and manage the delirium effectively and accurately. This reinforces the pivotal role of nurses in the early detection and prevention of delirium within the acute stroke care continuum. REGISTRATION The protocol was registered on PROSPERO (CRD42022352097). TWEETABLE ABSTRACT Evidence suggests 25 % prevalence of post-stroke delirium in acute settings, with higher rates in older patients, emphasizing the need for prevention, early detection, and management in nursing practice.
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Affiliation(s)
- Fen Ye
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Daniels C, Rodríguez-Antigüedad J, Jentschke E, Kulisevsky J, Volkmann J. Cognitive disorders in advanced Parkinson's disease: challenges in the diagnosis of delirium. Neurol Res Pract 2024; 6:14. [PMID: 38481336 PMCID: PMC10938698 DOI: 10.1186/s42466-024-00309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative condition that is frequently associated with cognitive disorders. These can arise directly from the primary disease, or be triggered by external factors in susceptible individuals due to PD or other predisposing factors. The cognitive disorders encompass PD-associated cognitive impairment (PD-CI), delirium, PD treatment-associated cognitive side effects, cognitive non-motor fluctuations, and PD-associated psychosis. Accurate diagnosis of delirium is crucial because it often stems from an underlying disease that may be severe and require specific treatment. However, overlapping molecular mechanisms are thought to be involved in both delirium and PD, leading to similar clinical symptoms. Additionally, there is a bidirectional interaction between delirium and PD-CI, resulting in frequent concurrent processes that further complicate diagnosis. No reliable biomarker is currently available for delirium, and the diagnosis is primarily based on clinical criteria. However, the screening tools validated for diagnosing delirium in the general population have not been specifically validated for PD. Our review addresses the current challenges in the diagnosis of these cognitive disorders and highlights existing gaps within this field.
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Affiliation(s)
- Christine Daniels
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Jon Rodríguez-Antigüedad
- Movement Disorders Unit, Sant Pau Hospital, Institut d'Investigacions Biomediques-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Elisabeth Jentschke
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Jaime Kulisevsky
- Movement Disorders Unit, Sant Pau Hospital, Institut d'Investigacions Biomediques-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
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Young J, Allan GM, Thomas B, Pasay D. A tale of two bladders: Understanding common bladder issues in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:103-106. [PMID: 38383012 PMCID: PMC11271834 DOI: 10.46747/cfp.7002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
| | - G Michael Allan
- Director of Programs and Practice Support at the College of Family Physicians of Canada
| | - Betsy Thomas
- Clinical Evidence Expert at the College of Family Physicians of Canada
| | - Darren Pasay
- Drug stewardship pharmacist for Alberta Health Services in Vegreville, Alta
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11
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Mei X, Liu YH, Han YQ, Zheng CY. Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients. World J Psychiatry 2023; 13:973-984. [PMID: 38186721 PMCID: PMC10768493 DOI: 10.5498/wjp.v13.i12.973] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It is associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department of cardiology, geriatric, and intensive care unit of hospital. With the increase in the aged population, further increases in delirium seem likely. However, it remains poorly recognized in the clinical practice. This article comprehensively discusses the latest research perspectives on the epidemiological data, risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium, including specific measures to manage delirium in clinical real-world situations. This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.
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Affiliation(s)
- Xi Mei
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Yue-Hong Liu
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Ya-Qing Han
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Cheng-Ying Zheng
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
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Miranda F, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings. Cochrane Database Syst Rev 2023; 11:CD013126. [PMID: 37987526 PMCID: PMC10661047 DOI: 10.1002/14651858.cd013126.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Delirium is an underdiagnosed clinical syndrome typified by an acute alteration of mental state. It is an important problem in critical care and intensive care units (ICU) due to its high prevalence and its association with adverse outcomes. Delirium is a very distressing condition for patients, with a huge impact on their well-being. Diagnosis of delirium in the critical care setting is challenging. This is especially true for patients who are mechanically ventilated and are therefore unable to engage in a verbal interview. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a tool specifically designed to assess for delirium in the context of ICU patients, including those on mechanical ventilation. CAM-ICU can be administered by non-specialists to give a dichotomous delirium present/absent result. OBJECTIVES To determine the diagnostic accuracy of the CAM-ICU for the diagnosis of delirium in adult patients in critical care units. SEARCH METHODS We searched MEDLINE (Ovid SP, 1946 to 8 July 2022), Embase (Ovid SP, 1982 to 8 July 2022), Web of Science Core Collection (ISI Web of Knowledge, 1945 to 8 July 2022), PsycINFO (Ovid SP, 1806 to 8 July 2022), and LILACS (BIREME, 1982 to 8 July 2022). We checked the reference lists of included studies and other resources for additional potentially relevant studies. We also searched the Health Technology Assessment database, the Cochrane Library, Aggressive Research Intelligence Facility database, WHO ICTRP, ClinicalTrials.gov, and websites of scientific associations to access any annual meetings and abstracts of conference proceedings in the field. SELECTION CRITERIA We included diagnostic studies enrolling adult ICU patients assessed using the CAM-ICU tool, regardless of language or publication status and reporting sufficient data on delirium diagnosis for the construction of 2 x 2 tables. Eligible studies evaluated the diagnostic performance of the CAM-ICU versus a clinical reference standard based on any iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria applied by a clinical expert. DATA COLLECTION AND ANALYSIS Two review authors independently selected and collated study data. We assessed the methodological quality of studies using the QUADAS-2 tool. We used two univariate fixed-effect or random-effects models to determine summary estimates of sensitivity and specificity. We performed sensitivity analyses that excluded studies considered to be at high risk of bias and high concerns in applicability, due mainly to the target population included (e.g. patients with traumatic brain injury). We also investigated potential sources of heterogeneity, assessing the effect of reference standard diagnosis and proportion of patients ventilated. MAIN RESULTS We included 25 studies (2817 participants). The mean age of participants ranged from 48 to 69 years; 15 of the studies included critical care units admitting mixed populations (e.g. medical, trauma, surgery patients). The percentage of patients receiving mechanical ventilation ranged from 11.8% to 100%. The prevalence of delirium in the studies included ranged from 12.5% to 83.9%. Presence of delirium was determined by the application of DSM-IV criteria in 13 out of 25 included studies. We assessed 13 studies as at low risk of bias and low applicability concerns for all QUADAS-2 domains. The most common issue of concern was flow and timing of the tests, followed by patient selection. Overall, we estimated a pooled sensitivity of 0.78 (95% confidence interval (CI) 0.72 to 0.83) and a pooled specificity of 0.95 (95% CI 0.92 to 0.97). Sensitivity analysis restricted to studies at low risk of bias and without any applicability concerns (n = 13 studies) gave similar summary accuracy indices (sensitivity 0.80 (95% CI 0.72 to 0.86), specificity 0.95 (95% CI 0.93 to 0.97)). Subgroup analyses based on diagnostic assessment found summary estimates of sensitivity and specificity for studies using DSM-IV of 0.79 (95% CI 0.72 to 0.85) and 0.94 (95% CI 0.90 to 0.96). For studies that used DSM-5 criteria, summary estimates of sensitivity and specificity were 0.75 (95% CI 0.67 to 0.82) and 0.98 (95% CI 0.95 to 0.99). DSM criteria had no significant effect on sensitivity (P = 0.421), but the specificity for detection of delirium was higher when DSM-5 criteria were used (P = 0.024). The relative specificity comparing DSM-5 versus DSM-IV criteria was 1.05 (95% CI 1.02 to 1.08). Summary estimates of sensitivity and specificity for studies recruiting < 100% of patients with mechanical ventilation were 0.81 (95% CI 0.75 to 0.85) and 0.95 (95% CI 0.91 to 0.98). For studies that exclusively recruited patients with mechanical ventilation, summary estimates of sensitivity and specificity were 0.91 (95% CI 0.76 to 0.97) and 0.98 (95% CI 0.92 to 0.99). Although there was a suggestion of differential performance of CAM-ICU in ventilated patients, the differences were not significant in sensitivity (P = 0.316) or in specificity (P = 0.493). AUTHORS' CONCLUSIONS The CAM-ICU tool may have a role in the early identification of delirium, in adult patients hospitalized in intensive care units, including those on mechanical ventilation, when non-specialized, properly trained clinical personnel apply the CAM-ICU. The test is most useful for exclusion of delirium. The test may miss a proportion of patients with incident delirium, therefore in situations where detection of all delirium cases is desirable, it may be best to repeat the test or combine CAM-ICU with another assessment. Future studies should compare different screening tests proposed for bedside assessment of delirium, as this approach will reveal which tool yields superior accuracy. In addition, future studies should consider and report the flow and timing of the tests and clearly report key characteristics related to patient selection. Finally, future research should focus on the impact of CAM-ICU screening on patient outcomes.
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Affiliation(s)
- Fabian Miranda
- Department of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Maria Nieves Plana
- Health Technology Assessment Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Pamela Seron
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación & CIGES, Universidad de La Frontera, Temuco, Chile
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Turner E, Robinson DM, Roaten K. Psychological Issues. Phys Med Rehabil Clin N Am 2023; 34:849-866. [PMID: 37806702 DOI: 10.1016/j.pmr.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Psychological distress is common following a burn injury, and many burn survivors have pre-morbid psychiatric illnesses including mood and trauma-related disorders, and substance and alcohol use. This article is intended to be used by all interdisciplinary health care team members to improve the identification and treatment of common psychological concerns experienced by survivors and is organized to follow the general recovery timeline.
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Affiliation(s)
- Emma Turner
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Diana M Robinson
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Kimberly Roaten
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
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Avelino-Silva TJ, Bittencourt JAS, Miguel CG, Rozzino TPDC, Vaccari AMH, Barbosa MS, Szlejf C. The Confusion Assessment Method in action: Implementation of a protocol to increase delirium screening and diagnosis. Geriatr Nurs 2023; 54:32-36. [PMID: 37703687 DOI: 10.1016/j.gerinurse.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
The use of the Confusion Assessment Method (CAM) for delirium assessment in real-life can be inconsistent. We examined the impact of a protocol on delirium screening and detection in hospitalized older adults using the CAM. We analyzed data from 32,338 admissions to a quaternary hospital between 2018 and 2022. We assessed the percentage of admissions screened for delirium, adherence to daily screening, positive screening, and overlap with ICD-10 coding. The percentage of admissions screened for delirium increased from 74% in 2018 to 98.7% in 2022. Adherence to daily screening was achieved in 24.5% of admissions, and the percentage of positive screenings fluctuated between 8.4% and 11.5%. Among the admissions with a delirium-related ICD-10 code, 32% had a positive screening, 62% were negative, and 6% remained unscreened. While implementing a protocol increased the proportion of admissions screened for delirium, adherence to daily screening and consistency of positive delirium screenings remain areas for improvement.
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Affiliation(s)
- Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento, Serviço de Geriatria, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo. Av. Dr. Enéas Carvalho de Aguiar 155, Prédio dos Ambulatórios, 8° Andar, Setor Azul, LIM-66, São Paulo, SP, 05304-000, Brazil; Global Brain Health Institute, University of California San Francisco. Attention: GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA
| | - José Adenaldo Santos Bittencourt
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - César Gomes Miguel
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Tatianna Pinheiro da Costa Rozzino
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Andreia Maria Heins Vaccari
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Michelle Simone Barbosa
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Claudia Szlejf
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil.
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15
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Lin CJ, Su IC, Huang SW, Chen PY, Traynor V, Chang HCR, Liu IH, Lai YS, Lee HC, Rolls K, Chiu HY. Delirium assessment tools among hospitalized older adults: A systematic review and metaanalysis of diagnostic accuracy. Ageing Res Rev 2023; 90:102025. [PMID: 37527704 DOI: 10.1016/j.arr.2023.102025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/08/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023]
Abstract
Delirium is a common neuropsychiatric syndrome that is often overlooked in clinical settings. The most accurate instrument for screening delirium has not been established. This study aimed to compare the diagnostic accuracy of the 4 'A's Test (4AT), Nursing Delirium Screening Scale (Nu-DESC), and Confusion Assessment Method (CAM) in detecting delirium among older adults in clinical settings. These assessment tools feature concise item sets and straightforward administration procedures. Five electronic databases were systematically searched from their inception to September 7, 2022. Studies evaluating the sensitivity and specificity of the 4AT, Nu-DESC, and CAM against the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases as the reference standard were included. Bivariate random effects model was used to summarize the sensitivity and specificity results. A total of 38 studies involving 7378 patients were included. The 4AT, Nu-DESC, and CAM had comparable sensitivity in detecting delirium (0.76, 0.78, and 0.80, respectively). However, the specificity of the CAM was higher than that of the 4AT (0.98 vs 0.89, P = .01) and Nu-DESC 0.99 vs 0.90, P = .003). Diagnostic accuracy was moderated by the percentage of women, acute care setting, sample size, and assessors. The three tools exhibit comparable sensitivity, and the CAM has the highest specificity. Based on the feasibility of the tools, nurses and clinical staffs could employ the Nu-DESC and the 4AT on screening out positive delirium cases and integrate these tools into daily practice. Further investigations are warranted to verify our findings.
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Affiliation(s)
- Chia-Jou Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - I-Chang Su
- Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Wen Huang
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Victoria Traynor
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Hui-Chen Rita Chang
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Australia
| | - I-Hsing Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yun-Shuan Lai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kaye Rolls
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
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16
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Sugi T, Enomoto T, Ohara Y, Furuya K, Kitaguchi D, Moue S, Akashi Y, Ogawa K, Owada Y, Oda T. Risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery: A single-center retrospective study. Ann Gastroenterol Surg 2023; 7:832-840. [PMID: 37663963 PMCID: PMC10472384 DOI: 10.1002/ags3.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 09/05/2023] Open
Abstract
Aim To investigate the risk factors for postoperative delirium among elderly patients undergoing elective surgery for gastroenterological cancer. Methods From May 2020 to March 2022, patients ≥75 years old with gastroenterological cancer who underwent radical surgery were enrolled. The geriatric assessment, including evaluations of frailty, physical function, nutrition status, and cognitive function, was conducted preoperatively. The confusion assessment method was used to diagnose postoperative delirium. A multivariate logistic regression analysis was used to determine risk factors for postoperative delirium. Results A total of 158 patients were eligible for inclusion in this study. Of these 53 patients (34%) developed postoperative delirium. In the univariate analysis, the age, regular use of sleeping drugs and benzodiazepine, Charlson Comorbidity Index score, performance status, Fried's frailty score, Vulnerable Elders Survey-13 score, grip weakness, Short Physical Performance Battery (SPPB) score, Mini Nutritional Assessment Short-Form score, and Mini-Mental State Examination score were statistically associated with the incidence of postoperative delirium. In the multivariate analysis, a SPPB score ≤9, Mini Nutritional Assessment score ≤11, a Mini-Mental State Examination score ≤24, and regular use of benzodiazepine were found to be independent preoperative risk factors for postoperative delirium. Conclusion Certain findings during the preoperative geriatric assessment, especially low SPPB, Mini Nutritional Assessment Short-Form and Mini-Mental State Examination scores, and regular use of benzodiazepine were risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery.
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Affiliation(s)
- Tomoyuki Sugi
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Daichi Kitaguchi
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Shoko Moue
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Yoshimasa Akashi
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Yohei Owada
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
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Ragheb J, Norcott A, Benn L, Shah N, McKinney A, Min L, Vlisides PE. Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives. BMC Health Serv Res 2023; 23:712. [PMID: 37386400 DOI: 10.1186/s12913-023-09681-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/10/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Delirium in hospitalized patients is a major public health issue, yet delirium is often unrecognized and missed during inpatient admission. The objective of this study was to identify barriers to delirium screening, identification, and management from a nursing perspective on inpatient, acute care units. METHODS This was a pre-implementation, diagnostic evaluation study to determine current practice patterns and potential barriers to optimizing delirium care at a major university hospital. A qualitative approach was used, which included focus groups of inpatient nurses working on major medical and surgical acute care units. Focus groups were conducted until signs of thematic saturation were present, and data were analyzed via inductive thematic analysis, without predetermined theories or structures. A consensus approach was utilized for transcript coding, and final themes were generated after multiple reviews of initial themes against transcript datasets. RESULTS Focus group sessions (n = 3) were held with 18 nurses across two major inpatient units. Nurses reported several barriers to successful delirium screening and management. Specific challenges included difficulty with using delirium screening tools, an organizational culture not conducive to delirium prevention, and competing clinical priorities. Proposed solutions were also discussed, including decision-support systems with automated pager alerts and associated delirium order sets, which may help improve delirium care coordination and standardization. CONCLUSION At a major university hospital, nurses affirm the difficulty experienced with delirium screening and identification, particularly due to screening tool challenges, cultural barriers, and clinical workload. These impediments may serve as targets for a future implementation trial to improve delirium screening and management.
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Affiliation(s)
- Jacqueline Ragheb
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Alexandra Norcott
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Lakeshia Benn
- Department of Inpatient Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- College of Health Professions & McAuley School of Nursing, University of Detroit Mercy, Detroit, MI, USA
| | - Nirav Shah
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Amy McKinney
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Lillian Min
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Michigan Medicine, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Department of Internal Medicine, Division of Geriatric Research, Education, and Clinical Centers (GRECC), Ann Arbor, MI, USA
| | - Phillip E Vlisides
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA.
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, USA.
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18
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Vlisides PE, Ragheb J, McKinney A, Mentz G, Runstadler N, Martinez S, Jewell E, Lee U, Vanini G, Schmitt EM, Inouye SK, Mashour GA. Caffeine, Postoperative Delirium And Change In Outcomes after Surgery (CAPACHINOS)-2: protocol for a randomised controlled trial. BMJ Open 2023; 13:e073945. [PMID: 37188468 PMCID: PMC10186430 DOI: 10.1136/bmjopen-2023-073945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Delirium is a major public health issue for surgical patients and their families because it is associated with increased mortality, cognitive and functional decline, prolonged hospital admission and increased healthcare expenditures. Based on preliminary data, this trial tests the hypothesis that intravenous caffeine, given postoperatively, will reduce the incidence of delirium in older adults after major non-cardiac surgery. METHODS AND ANALYSIS The CAffeine, Postoperative Delirium And CHange In Outcomes after Surgery-2 (CAPACHINOS-2) Trial is a single-centre, placebo-controlled, randomised clinical trial that will be conducted at Michigan Medicine. The trial will be quadruple-blinded, with clinicians, researchers, participants and analysts all masked to the intervention. The goal is to enrol 250 patients with a 1:1:1: allocation ratio: dextrose 5% in water placebo, caffeine 1.5 mg/kg and caffeine 3 mg/kg as a caffeine citrate infusion. The study drug will be administered intravenously during surgical closure and on the first two postoperative mornings. The primary outcome will be delirium, assessed via long-form Confusion Assessment Method. Secondary outcomes will include delirium severity, delirium duration, patient-reported outcomes and opioid consumption patterns. A substudy analysis will also be conducted with high-density electroencephalography (72-channel system) to identify neural abnormalities associated with delirium and Mild Cognitive Impairment at preoperative baseline. ETHICS AND DISSEMINATION This study was approved by the University of Michigan Medical School Institutional Review Board (HUM00218290). An independent data and safety monitoring board has also been empanelled and has approved the clinical trial protocol and related documents. Trial methodology and results will be disseminated via clinical and scientific journals along with social and news media. TRIAL REGISTRATION NUMBER NCT05574400.
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Affiliation(s)
- Phillip E Vlisides
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Amy McKinney
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Graciela Mentz
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | | | - UnCheol Lee
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Giancarlo Vanini
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva M Schmitt
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA
| | - George A Mashour
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
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19
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Ní Chróinín D, Alexandrou E, Frost SA. Delirium in the intensive care unit and its importance in the post-operative context: A review. Front Med (Lausanne) 2023; 10:1071854. [PMID: 37064025 PMCID: PMC10098316 DOI: 10.3389/fmed.2023.1071854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/10/2023] [Indexed: 04/18/2023] Open
Abstract
The burden of delirium in the intensive care setting is a global priority. Delirium affects up to 80% of patients in intensive care units; an episode of delirium is often distressing to patients and their families, and delirium in patients within, or outside of, the intensive care unit (ICU) setting is associated with poor outcomes. In the short term, such poor outcomes include longer stay in intensive care, longer hospital stay, increased risk of other hospital-acquired complications, and increased risk of hospital mortality. Longer term sequelae include cognitive impairment and functional dependency. While medical category of admission may be a risk factor for poor outcomes in critical care populations, outcomes for surgical ICU admissions are also poor, with dependency at hospital discharge exceeding 30% and increased risk of in-hospital mortality, particularly in vulnerable groups, with high-risk procedures, and resource-scarce settings. A practical approach to delirium prevention and management in the ICU setting is likely to require a multi-faceted approach. Given the good evidence for the prevention of delirium among older post-operative outside of the intensive care setting, simple non-pharmacological interventions should be effective among older adults post-operatively who are cared for in the intensive care setting. In response to this, the future ICU environment will have a range of organizational and distinct environmental characteristics that are directly targeted at preventing delirium.
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Affiliation(s)
- Danielle Ní Chróinín
- Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Evan Alexandrou
- Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
- Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Steven A. Frost
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- SWS Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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20
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Shrestha P, Fick DM. Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool? Geriatrics (Basel) 2023; 8:22. [PMID: 36826364 PMCID: PMC9957529 DOI: 10.3390/geriatrics8010022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an "ideal" tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD.
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Affiliation(s)
- Priyanka Shrestha
- Community of Policy, Populations and Systems, The George Washington University School of Nursing, Washington, DC 20006, USA
| | - Donna M. Fick
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA 16802, USA
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21
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Drazich BF, Boltz M, Kuzmik A, Galik E, Kim N, McPherson R, Holmes S, Resnick B. The association of physical activity and behavioral and psychological symptoms among a sample of hospitalized older adults living with dementia. Int J Geriatr Psychiatry 2023; 38:e5885. [PMID: 36734152 PMCID: PMC10495074 DOI: 10.1002/gps.5885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aims of this study were to: (1) describe the prevalence of behavioral and psychological symptoms of dementia in hospitalized older adults living with dementia and (2) examine the association of physical activity and behavioral and psychological symptoms of dementia among hospitalized older adults living with dementia, after controlling for covariates. METHODS Physical activity was measured using the Physical Activity Survey and behavioral and psychological symptoms of dementia were measured using the Neuropsychiatric Inventory. Descriptive analysis and multiple linear regressions were run using baseline data on 294 older adults with dementia hospitalized on general medical units from an ongoing study entitled Function Focused Care for Acute Care Using the Evidence Integration Triangle. RESULTS Participants performed an average of 7.92 (SD = 4.49) of 34 possible activities "in the last 24 h" prior to the Physical Activity Survey administration. A total of 132 participants (45.5%) had at least one behavioral and psychological symptom of dementia. We found that physical activity was not associated with behavioral and psychological symptoms of dementia (b = 0.01; p = 0.56), after controlling for covariates. CONCLUSIONS Although this study found no evidence of an association between physical activity and behavioral and psychological symptoms of dementia, evidence of physical activity did not exacerbate these behaviors. Thus, given the benefits of physical activity, it is important to continue to encourage patients living with dementia to engage in activity.
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Affiliation(s)
- Brittany F. Drazich
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Marie Boltz
- School of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Ashley Kuzmik
- School of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Nayeon Kim
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Sarah Holmes
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
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22
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Herrera E, Rutherford W, Plume T, Fields W, Mollon D. Evaluation of Education and Patient Screening for Delirium Among Patients With Stroke: Knowledge, Confidence, and Patient Outcomes. J Contin Educ Nurs 2023; 54:61-70. [PMID: 36720098 DOI: 10.3928/00220124-20230113-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical staff showed a knowledge deficit with identifying and managing delirium. The effect of a validated assessment tool and delirium education on staff knowledge and confidence and patient outcomes was analyzed. METHOD A descriptive qualitative and quantitative pre- and postintervention study analyzed the demographics of patients with stroke and clinical outcomes pre- and postimplementation of an assessment tool and delirium staff education. RESULTS Early and frequent delirium assessments, use of an assessment tool, a delirium order set, and education for clinical staff resulted in increased knowledge and confidence with identifying and managing patients with stroke, an increase in the number of patients with stroke discharged home, and decreased incidence of hospital-acquired urinary tract infection and pneumonia. CONCLUSION Delirium education positively impacts staff knowledge and confidence with the identification and management of delirium. Patients with an acute stroke may benefit from early and frequent delirium assessments. Staff education, structured assessment frequency with a validated assessment tool, and specific interventions affect patient outcomes, such as infection rates and discharge level of care. [J Contin Educ Nurs. 2023;54(2):61-70.].
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23
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Ma X, Chu H, Han K, Shao Q, Yu Y, Jia S, Wang D, Wang Z, Zhou Y. Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta-analysis. J Am Geriatr Soc 2023; 71:646-660. [PMID: 36419366 DOI: 10.1111/jgs.18104] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/19/2022] [Accepted: 09/24/2022] [Indexed: 11/25/2022]
Abstract
AIMS To perform an updated systematic review and meta-analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). METHODS We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. RESULTS A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%-11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%-23.7%). According to the level of evidence and results of meta-analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non-transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79-2.71; pooled adjusted RR: 1.62, 95% CI: 1.25-2.10), particularly long-term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91-4.23; pooled adjusted HR: 1.88, 95% CI: 1.30-2.73). CONCLUSIONS POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.
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Affiliation(s)
- Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huijun Chu
- Department of Anesthesia, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Kangning Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiaoyu Shao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dunliang Wang
- Department of Anesthesia, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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24
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Kim SB, Bong SH, Lee JH, Choi TY, Yoon SY, Kim JW. The Usefulness of Quantitative Electroencephalography in Diagnosis and Severity Evaluation of Delirium: A Retrospective Study. Psychiatry Investig 2023; 20:144-151. [PMID: 36891599 PMCID: PMC9996146 DOI: 10.30773/pi.2022.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/09/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Incontrovertible disease markers are absent in delirium. This study investigated the usefulness of quantitative electroencephalography (qEEG) in diagnosing delirium. METHODS This retrospective case-control study reviewed medical records and qEEG data of 69 age/sex-matched patients (delirium group, n=30; control group, n=39). The first minute of artifact-free EEG data with eyes closed was selected. Nineteen electrodes' sensitivity, specificity, and correlation with delirium rating scale-revised-98 were analyzed. RESULTS On comparing the means of absolute power by frontal, central, and posterior regions, the delta and theta powers showed significant differences (p<0.001) in all regions, and the magnitude of the absolute power was higher in the delirium group than in the control group; only the posterior region showed a significant (p<0.001) difference in beta power. The spectral power of theta at the frontal region (area under the curve [AUC]=0.84) and theta at the central and posterior regions (AUC=0.83) showed 90% sensitivity and 79% specificity, respectively, in differentiating delirious patients and controls. The beta power of the central region showed a significant negative correlation with delirium severity (R=-0.457, p=0.011). CONCLUSION Power spectrum analysis of qEEG showed high accuracy in screening delirium among patients. The study suggests qEEG as a potential aid in diagnosing delirium.
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Affiliation(s)
- Seung Bhin Kim
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Su Hyun Bong
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jong Hun Lee
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Tae Young Choi
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Seo Young Yoon
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
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25
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Bayer TA, Van Patten R, Hershkowitz D, Epstein-Lubow G, Rudolph JL. Comorbidity and Management of Concurrent Psychiatric and Medical Disorders. Psychiatr Clin North Am 2022; 45:745-763. [PMID: 36396277 DOI: 10.1016/j.psc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aging increases susceptibility to medical and psychiatric comorbidity via interrelated biological, psychological, and social mechanisms. Mental status changes or other psychiatric symptoms occurring in older adults with medical disorders most often result from delirium, depression, or the onset of Alzheimer's disease and related dementias (ADRD). Clinicians can use evidence-based tools to evaluate such symptoms including the 4A's Test for delirium, the Saint Louis University Mental Status Exam, and the Geriatric Depression Scale. Innovative models such as collaborative care can improve the outcome of care of older adults with medical disorders requiring treatment for depression or ADRD..
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Affiliation(s)
- Thomas A Bayer
- Long-term Services and Supports Center of Innovation, Providence VA Medical Center, 353-373 Niagara St., Providence, RI 02907, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, 593 Eddy St., POB 438, Providence, RI 02903, USA.
| | - Ryan Van Patten
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 593 Eddy Street, APC9 Providence, RI 02903, USA
| | - Dylan Hershkowitz
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 593 Eddy Street, APC9 Providence, RI 02903, USA
| | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 593 Eddy Street, APC9 Providence, RI 02903, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903, USA; Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA
| | - James L Rudolph
- Long-term Services and Supports Center of Innovation, Providence VA Medical Center, 353-373 Niagara St., Providence, RI 02907, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, 593 Eddy St., POB 438, Providence, RI 02903, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903, USA
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26
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Lisibach A, Gallucci G, Benelli V, Kälin R, Schulthess S, Beeler PE, Csajka C, Lutters M. Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients - A cohort study comparing 19 anticholinergic burden scales. Br J Clin Pharmacol 2022; 88:4915-4927. [PMID: 35675080 PMCID: PMC9796852 DOI: 10.1111/bcp.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS A recent review identified 19 anticholinergic burden scales (ABSs) but no study has yet compared the impact of all 19 ABSs on delirium. We evaluated whether a high anticholinergic burden as classified by each ABS is associated with incident delirium. METHOD We performed a retrospective cohort study in a Swiss tertiary teaching hospital using data from 2015-2018. Included were patients aged ≥65, hospitalised ≥48 hours with no stay >24 hours in intensive care. Delirium was defined twofold: (i) ICD-10 or CAM and (ii) ICD-10 or CAM or DOSS. Patients' cumulative anticholinergic burden score, calculated within 24 hours after admission, was classified using a binary (<3: low, ≥3: high burden) and a categorical approach (0: no, 0.5-3: low, ≥3: high burden). Association was analysed using multivariable logistic regression. RESULTS Over 25 000 patients (mean age 77.9 ± 7.6 years) were included. Of these, (i) 864 (3.3%) and (ii) 2770 (11.0%) developed delirium. Depending on the evaluated ABS, 4-63% of the patients were exposed to at least one anticholinergic drug. Out of 19 ABSs, (i) 14 and (ii) 16 showed a significant association with the outcomes. A patient with a high anticholinergic burden score had odds ratios (ORs) of 1.21 (95% confidence interval [CI]: 1.03-1.42) to 2.63 (95% CI: 2.28-3.03) for incident delirium compared to those with low or no burden. CONCLUSION A high anticholinergic burden within 24 hours after admission was significantly associated with incident delirium. Although prospective studies need to confirm these results, discontinuing or substituting drugs with a score of ≥3 at admission might be a targeted intervention to reduce incident delirium.
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Affiliation(s)
- Angela Lisibach
- Clinical Pharmacy, Department Medical ServicesCantonal Hospital of BadenBadenSwitzerland,Center for Research and Innovation in Clinical Pharmaceutical SciencesUniversity Hospital and University of LausanneLausanneSwitzerland,School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland,Institute of Pharmaceutical Sciences of Western Switzerland, University of GenevaUniversity of LausanneSwitzerland
| | - Giulia Gallucci
- Clinical Pharmacy, Department Medical ServicesCantonal Hospital of BadenBadenSwitzerland
| | - Valérie Benelli
- Clinical Pharmacy, Department Medical ServicesCantonal Hospital of BadenBadenSwitzerland
| | - Ramona Kälin
- Clinical Pharmacy, Department Medical ServicesCantonal Hospital of BadenBadenSwitzerland
| | - Sven Schulthess
- Clinical Pharmacy, Department Medical ServicesCantonal Hospital of BadenBadenSwitzerland
| | - Patrick E. Beeler
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention InstituteUniversity of Zurich & University Hospital ZurichZurichSwitzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical SciencesUniversity Hospital and University of LausanneLausanneSwitzerland,School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland,Institute of Pharmaceutical Sciences of Western Switzerland, University of GenevaUniversity of LausanneSwitzerland
| | - Monika Lutters
- Clinical Pharmacy, Department Medical ServicesCantonal Hospital of BadenBadenSwitzerland,Swiss Federal Institute of TechnologyZurichSwitzerland
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27
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Affiliation(s)
- Kathleen S Bingham
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
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28
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Fong TG, Hshieh TT, Tabloski PA, Metzger ED, Arias F, Heintz HL, Patrick RE, Lapid MI, Schmitt EM, Harper DG, Forester BP, Inouye SK. Identifying Delirium in Persons With Moderate or Severe Dementia: Review of Challenges and an Illustrative Approach. Am J Geriatr Psychiatry 2022; 30:1067-1078. [PMID: 35581117 PMCID: PMC10413471 DOI: 10.1016/j.jagp.2022.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023]
Abstract
Delirium and dementia are common causes of cognitive impairment among older adults, which often coexist. Delirium is associated with poor clinical outcomes, and is more frequent and more severe in patients with dementia. Identifying delirium in the presence of dementia, also described as delirium superimposed on dementia (DSD), is particularly challenging, as symptoms of delirium such as inattention, cognitive dysfunction, and altered level of consciousness, are also features of dementia. Because DSD is associated with poorer clinical outcomes than dementia alone, detecting delirium is important for reducing morbidity and mortality in this population. We review a number of delirium screening instruments that have shown promise for use in DSD, including the 4-DSD, combined Six Item Cognitive Impairment Test (6-CIT) and 4 'A's Test (4AT), Confusion Assessment Method (CAM), and the combined UB2 and 3D-CAM (UB-CAM). Each has advantages and disadvantages. We then describe the operationalization of a CAM-based approach in a current ECT in dementia project as an example of modifying an existing instrument for patients with moderate to severe dementia. Ultimately, any instrument modified will need to be validated against a standard clinical reference, in order to fully establish its sensitivity and specificity in the moderate to severe dementia population. Future work is greatly needed to advance the challenging area of accurate identification of delirium in moderate or severe dementia.
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Affiliation(s)
- Tamara G Fong
- Departments of Neurology (TGF, FA), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA.
| | - Tammy T Hshieh
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA; Department of Medicine (TTH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Eran D Metzger
- Departments of Psychiatry (EDM), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Franchesca Arias
- Departments of Neurology (TGF, FA), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA
| | - Hannah L Heintz
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | - Regan E Patrick
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | | | - Eva M Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA
| | - David G Harper
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | - Brent P Forester
- Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA
| | - Sharon K Inouye
- Departments of Medicine (SKI), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA
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29
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Radcliffe NJ, Lau L, Hack E, Huynh A, Puri A, Yao H, Wong A, Kohler S, Chua M, Amadoru S, Haywood C, Yates P. Site of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks. Intern Med J 2022; 53:690-699. [PMID: 36008359 PMCID: PMC9539151 DOI: 10.1111/imj.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Residential InReach presents an alternative to hospital admission for aged care residents swabbed for COVID-19, though relative outcomes remain unknown. AIMS To compare rates and predictors of 28-day mortality for aged care residents seen by InReach with COVID-19, or 'suspected COVID-19' ('sCOVID'), including hospital vs InReach-based care. METHODS Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID-19 testing criteria between April-October 2020 (pre-vaccine availability). COVID-19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID-19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative. RESULTS There were no significant differences in age, gender, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID-19 and 118 patients with sCOVID. 28-day mortality was similar between patients with COVID-19 (35/152, 23%) and sCOVID (32/118, 27%) (p=0.4). For the combined cohort, 28-day mortality was associated with initial oxygen saturation (p<0.001), delirium (p<0.001), hospital transfer for acuity (p=0.02; but not public health/facility reasons), CFS (p=0.04), prior ischaemic heart disease (p=0.01) and dementia (p=0.02). For COVID-19 patients, 28-day mortality was associated with initial oxygen saturation (p=0.02), delirium (p<0.001), and hospital transfer for acuity (p=0.01), but not public health/facility reasons. CONCLUSION Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nicholas J Radcliffe
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Liza Lau
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Emma Hack
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Huynh
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Florey Neuroscience Institute, Melbourne, Victoria, Australia
| | - Arvind Puri
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Henry Yao
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Aaron Wong
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Melbourne Health, Parkville, Melbourne, Australia
| | - Sabrina Kohler
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Maggie Chua
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - Sanka Amadoru
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Cilla Haywood
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Department of Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - Paul Yates
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Department of Medicine, Austin Health, Melbourne, Victoria, Australia.,Florey Neuroscience Institute, Melbourne, Victoria, Australia
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Delirium in Nursing Home Residents: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10081544. [PMID: 36011202 PMCID: PMC9407867 DOI: 10.3390/healthcare10081544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Delirium is an important component of the geriatric syndromes and has been recognized to negatively influence the prognosis of older people in hospital and in a post-acute setting. About 2–5% of older people world-wide live in nursing homes and are characterized by functional impairment, cognitive decline, dementia, comorbidities, and polypharmacotherapy, all factors which influence the development of delirium. However, in this setting, delirium remains often understudied. Therefore, in this narrative review, we aimed to describe the latest evidence regarding delirium screening tools, epidemiology characteristics, outcomes, risk factors, and preventions strategies in nursing homes.
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The Application of the Nurse-Led Sedation and Analgesia Management in ICU after Heart Surgeries. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7706172. [PMID: 35836831 PMCID: PMC9276485 DOI: 10.1155/2022/7706172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
Aim Traditional sedation management consists of doctors adjusting the dosage of sedative drugs or adding other drugs in combination according to the evaluation of nurses; the nurses then execute the orders. The nurses' passive execution in the process is not the ideal model for continuous evaluation and observation of sedation. This study aims to investigate the application and effects of nurse-provided procedural sedation and analgesia for patients in intensive care unit. Methods The experimental group consisted of 354 heart surgery patients who received procedural sedation and analgesia from nurses from November 2020 to August 2021. The control group consisted of 301 patients who had had heart surgery and received the traditional sedation management program from January to October 2020. The differences in levels of the sedative effect, delirium, and unplanned extubation of patients between these two groups were compared. Results There were no significant differences in baseline characteristics between the two groups (P > 0.05). It was found that both insufficient sedation and excessive sedation decreased in the experimental group when compared to the control group, while the appropriate proportion of sedation increased (72.41% versus 37.98%); the difference was statistically significant (P < 0.05). The incidence of delirium was lower for patients in the experimental group than for patients in the control group (37.01% versus 66.45%); the difference was statistically significant (P < 0.05). The incidence of unplanned extubation caused by patient factors was lower for the experimental group than for the control group, but the difference was not statistically significant (P > 0.05). Conclusion The programmed sedation scheme led by nurses can improve the sedation effect and reduce the incidence of delirium. Implications for Practice. The management team gives the sedative goal and establishes the standard flowchart. The sedation management led by the nurse according to the goal and flowchart is better than the traditional sedation management.
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Kong H, Xu LM, Wang DX. Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment. CNS Neurosci Ther 2022; 28:1147-1167. [PMID: 35652170 PMCID: PMC9253756 DOI: 10.1111/cns.13873] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Perioperative neurocognitive disorders (NCDs) refer to neurocognitive abnormalities detected during the perioperative periods, including preexisting cognitive impairment, preoperative delirium, delirium occurring up to 7 days after surgery, delayed neurocognitive recovery, and postoperative NCD. The Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5) is the golden standard for diagnosing perioperative NCDs. Given the impracticality of using the DSM‐5 by non‐psychiatric practitioners, many diagnostic tools have been developed and validated for different clinical scenarios. The etiology of perioperative NCDs is multifactorial and includes predisposing and precipitating factors. Identifying these risk factors is conducive to preoperative risk stratification and perioperative risk reduction. Prevention for perioperative NCDs should include avoiding possible contributors and implementing nonpharmacologic and pharmacological interventions. The former generally includes avoiding benzodiazepines, anticholinergics, prolonged liquid fasting, deep anesthesia, cerebral oxygen desaturation, and intraoperative hypothermia. Nonpharmacologic measures include preoperative cognitive prehabilitation, comprehensive geriatric assessment, implementing fast‐track surgery, combined use of regional block, and sleep promotion. Pharmacological measures including dexmedetomidine, nonsteroidal anti‐inflammatory drugs, and acetaminophen are found to have beneficial effects. Nonpharmacological treatments are the first‐line measures for established perioperative NCDs. Pharmacological treatments are still limited to severely agitated or distressed patients.
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Affiliation(s)
- Hao Kong
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Long-Ming Xu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China.,Outcomes Research Consortium, Cleveland, Ohio, USA
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Wiegand TLT, Rémi J, Dimitriadis K. Electroencephalography in delirium assessment: a scoping review. BMC Neurol 2022; 22:86. [PMID: 35277128 PMCID: PMC8915483 DOI: 10.1186/s12883-022-02557-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/13/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Delirium is a common disorder affecting around 31% of patients in the intensive care unit (ICU). Delirium assessment scores such as the Confusion Assessment Method (CAM) are time-consuming, they cannot differentiate between different types of delirium and their etiologies, and they may have low sensitivities in the clinical setting. While today, electroencephalography (EEG) is increasingly being applied to delirious patients in the ICU, a lack of clear cut EEG signs, leads to inconsistent assessments. METHODS We therefore conducted a scoping review on EEG findings in delirium. One thousand two hundred thirty-six articles identified through database search on PubMed and Embase were reviewed. Finally, 33 original articles were included in the synthesis. RESULTS EEG seems to offer manifold possibilities in diagnosing delirium. All 33 studies showed a certain degree of qualitative or quantitative EEG alterations in delirium. Thus, normal routine (rEEG) and continuous EEG (cEEG) make presence of delirium very unlikely. All 33 studies used different research protocols to at least some extent. These include differences in time points, duration, conditions, and recording methods of EEG, as well as different patient populations, and diagnostic methods for delirium. Thus, a quantitative synthesis and common recommendations are so far elusive. CONCLUSION Future studies should compare the different methods of EEG recording and evaluation to identify robust parameters for everyday use. Evidence for quantitative bi-electrode delirium detection based on increased relative delta power and decreased beta power is growing and should be further pursued. Additionally, EEG studies on the evolution of a delirium including patient outcomes are needed.
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Affiliation(s)
- Tim L T Wiegand
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Neurology, University Hospital, Ludwig Maximilian University, 15 Marchioninistr, 81377, Munich, Germany
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig Maximilian University, 15 Marchioninistr, 81377, Munich, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology, University Hospital, Ludwig Maximilian University, 15 Marchioninistr, 81377, Munich, Germany.
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilians University, Munich, Germany.
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Loehr VG, Goette WF, Roaten K. Screening and Assessment for Psychological Distress among Burn Survivors. EUROPEAN BURN JOURNAL 2022; 3:57-88. [PMID: 39604177 PMCID: PMC11575395 DOI: 10.3390/ebj3010008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2024]
Abstract
Given the high rates of psychological distress after burn injury, thorough screening and assessment for psychosocial factors and psychiatric pathology should be routinely completed for individuals with burn injuries. Burn survivors experience unique psychosocial changes and injury sequelae, such as body image concerns, trauma-related pathology, and itching. Screening for these factors is integral to understanding how these may be contributing to psychological distress. Proactively identifying distress and psychiatric pathology is important to optimize physical and emotional outcomes. The aim of this manuscript is to summarize information about the available screening and assessment tools for psychological distress among burn survivors.
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Affiliation(s)
- Valerie G. Loehr
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390-8898, USA; (W.F.G.); (K.R.)
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Vybornykh DE, Zakharov VV, Gemdzhian EG, Drokov MY, Fedorova SY, Khrushchev SO. [Predictors of severe lesions of the central nervous system in the treatment of blood system diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:33-38. [PMID: 34932283 DOI: 10.17116/jnevro202112111133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the types, frequency and key symptoms of severe lesions of the central nervous system (SLCNS) that occurred in patients with hematological malignancies (HM). MATERIALS AND METHODS The authors conducted a retrospective exploratory study by analyzing the data of 3.620 patients with HM during the period from 01.01.18 to 31.12.19. Thirty-four patients (14 men and 20 women, median age 39 years), who developed SLCNS during treatment, were selected. For comparison with the main group of patients and exclusion of predictors associated with the development of SLCNS, a comparison group was added (by Kernel matching method). A comparison group consisted of 137 patients (59 men and 78 women, median age - 36 years) and was similar to the main group by clinical and laboratory characteristics. A neurological complication was marked as SLCNS if it was an indication for transfer to the intensive care unit (ICU). Statistical analysis included multivariate analysis - multiple binary logistic regression with stepwise inclusion of variables (that were found in the preliminary contingency table analysis) in the model, with control false results (by the false discovery rate method) and estimating the odds ratio, OR (95% CI). RESULTS SLCNS in patients with HM developed in 0.94% of cases. The main SLCNS in patients with HM were: epileptic seizure (50.0%, n=17), ischemic stroke (20.6%, n=7), hemorrhagic stroke (17.6%, n=6) and meningoencephalitis (11.8%, n=4). The following independent significant (Wald test p≤0.05) predictors associated with the development of SLCNS in patients with HM during inpatient treatment were identified: antibiotic therapy (when more than 5 drugs are prescribed), OR=2.9 (1.2-7, four); polychemotherapy (if more than 4 drugs are prescribed), OR=2.9 (1.1-7.8); thrombocytopenia (with a platelet count less than 50·109 g/l), OR=2.3 (1.0-5.2) and delirium, OR=3.7 (1.3-10.8), and also the presence of neurological disorders in the patient's history, OR=2.6 (1.1-6.3). CONCLUSION The main types of SLCNS in patients with HM were: epileptic seizure, ischemic and hemorrhagic strokes, and meningoencephalitis. Four predictors associated with the development of SLCNS in the course of HM treatment were identified: massive antibacterial (with more than 5 drugs) and chemotherapeutic (with more than 4 drugs) effects, thrombocytopenia and manifestation of delirium, as well as one risk factor: a history of neurological disorder. These factors need to be considered and monitored during treatment, because each of them increases the risk of developing SLCNS.
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Affiliation(s)
- D E Vybornykh
- National Research Center for Hematology, Moscow, Russia
| | - V V Zakharov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E G Gemdzhian
- National Research Center for Hematology, Moscow, Russia
| | - M Yu Drokov
- National Research Center for Hematology, Moscow, Russia
| | - S Yu Fedorova
- National Research Center for Hematology, Moscow, Russia
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The Risk Factors for Delirium in Patients with Stroke in Palliative Care. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.969181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Delirium, sometimes referred to as encephalopathy, is an acute confusional state that is both common in hospitalized patients and associated with poor outcomes. For patients, families, and caregivers, delirium can be a traumatic experience. While delirium is one of the most common diagnoses encountered by the consulting neurologist, the majority of the time it will have been previously unrecognized as such by the care team. Neurologic syndromes such as dementia or aphasia can either be misdiagnosed as delirium or may coexist with it, necessitating careful neurologic assessment. Once the diagnosis of delirium has been established, a careful evaluation for predisposing and precipitating factors can help uncover modifiable contributors, which should be addressed as part of a multicomponent, primarily nonpharmacologic intervention. Importantly, delirium management, which begins with comprehensive prevention, should emphasize the humanity of the delirious patient and the challenges of caring for this vulnerable population. When considered, delirium represents an important opportunity for the neurologist to substantially enhance patient care.
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Affiliation(s)
- Sophia L Ryan
- Department of Neurology, Mount Sinai Medical Center, New York, New York
| | - Eyal Y Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Reynish E, Hapca S, Walesby R, Pusram A, Bu F, Burton JK, Cvoro V, Galloway J, Ebbesen Laidlaw H, Latimer M, McDermott S, Rutherford AC, Wilcock G, Donnan P, Guthrie B. Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions.
Objective
This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013.
Design
For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost.
Data sources
Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set.
Results
In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower.
Limitations
A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders.
Conclusions
Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways.
Future work
Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital.
Study registration
This study is registered as PROSPERO CRD42015024492.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma Reynish
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Simona Hapca
- School of Medicine, University of Dundee, Dundee, UK
| | - Rebecca Walesby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Angela Pusram
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Feifei Bu
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Jennifer K Burton
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Vera Cvoro
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - James Galloway
- Health Informatics Centre, University of Dundee, Dundee, UK
| | | | - Marion Latimer
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | | | - Gordon Wilcock
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Peter Donnan
- School of Medicine, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- School of Medicine, University of Dundee, Dundee, UK
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Reppas-Rindlisbacher C, Siddhpuria S, Wong EKC, Lee JY, Gabor C, Curkovic A, Khalili Y, Mavrak C, De Freitas S, Eshak K, Patterson C. Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project. BMJ Open Qual 2021; 10:bmjoq-2020-001186. [PMID: 33526446 PMCID: PMC7853031 DOI: 10.1136/bmjoq-2020-001186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/11/2022] Open
Abstract
Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit. The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.
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Affiliation(s)
| | - Shailee Siddhpuria
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Kai-Chung Wong
- Division of Geriatric Medicine, University of Toronto Department of Medicine, Toronto, Ontario, Canada.,Geriatric Education and Research in Aging Science (GERAS) Centre, McMaster University, Hamilton, Ontario, Canada
| | - Justin Yusen Lee
- Geriatric Education and Research in Aging Science (GERAS) Centre, McMaster University, Hamilton, Ontario, Canada.,Division of Geriatric Medicine, McMaster University Department of Medicine, Hamilton, Ontario, Canada.,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | | | - Sandra De Freitas
- Hamilton Health Sciences, Hamilton, Ontario, Canada.,Joseph Brant Memorial Hospital, Burlington, Ontario, Canada
| | - Kristeen Eshak
- Division of Geriatric Medicine, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Christopher Patterson
- Geriatric Education and Research in Aging Science (GERAS) Centre, McMaster University, Hamilton, Ontario, Canada .,Division of Geriatric Medicine, McMaster University Department of Medicine, Hamilton, Ontario, Canada.,Hamilton Health Sciences, Hamilton, Ontario, Canada
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Delirium Triage Screen/Brief Confusion Assessment Method in Adult Orthopaedic and Hematological Patients: A Validation Study. Orthop Nurs 2021; 40:16-22. [PMID: 33492905 DOI: 10.1097/nor.0000000000000726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Delirium in the hospitalized orthopaedic patient is associated with numerous negative outcomes. Assessing for the presence of delirium using an accurate and reliable tool is essential. However, the number of validated screening tools is limited. The purpose of this study was to validate and test the reliability of the Delirium Triage Screening and brief Confusion Assessment Method (DTS/bCAM) to screen for delirium in non-intensive care (ICU) orthopaedic and hematological patients. This was a prospective, observational study. Seventy-six delirium assessments were completed on 19 orthopaedic patients and 10 hematological patients. The clinical nurse performed the DTS/bCAM during every 12-hour shift. Within 2 hours of this assessment, a research investigator performed both the DTS/bCAM and the Confusion Assessment Method (CAM). Each patient had a maximum of three assessments by a research investigator. Interrater reliability for the clinical nurse and the researcher was measured through comparison of positive and negative DTS/bCAM results. Validity was measured by comparing the matched DTS/bCAM and CAM results, both performed by the researcher. The DTS/bCAM and CAM results had 100% agreement. Two patients (7%) screened positive for delirium. Sensitivity of the DTS/bCAM was 100% (95% CI [15.8-100]) and specificity was 100% (95% CI [95.1, 100]). There was 86% agreement (43/50) between the clinical nurse and the researcher for the DTS/bCAM. In adult orthopaedic and hematological patients not receiving intensive care, the DTS/bCAM may be a valid, reliable, and rapid screening tool for delirium.
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Screening and detection of delirium in an adult critical care setting: a best practice implementation project. JBI Evid Implement 2021; 19:337-346. [PMID: 34810405 DOI: 10.1097/xeb.0000000000000267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess compliance with evidence-based practice regarding screening and detection of delirium in adult patients at the ICU from a university hospital. METHODS The compliance rates were evaluated using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. This strategy was designed in three phases: (1) establishing a team and conducting a baseline audit based on criteria informed by the evidence; (2) reflecting on the results of the baseline audit and designing and implementing strategies to address noncompliance found in the baseline audit informed by the JBI Getting Research into Practice framework; and (3) conducting a follow-up audit to assess the outcomes of the interventions implemented to improve practice and identify future practice issues to be addressed in subsequent audits. The implementation protocol was designed based on the primary barriers and facilitators identified in the baseline audit, allied to a training program and electronic medical records changes. Nursing documentation available in medical records from patients admitted in the ICU was used to assess the baseline and follow-up audit compliance rates. RESULTS None of the medical records evaluated before the implementation protocol showed compliance with the following audit criteria: a valid and reliable instrument is accessible in the ward environment (0%), the nursing care documentation supports that the Confusion Assessment Method for the Intensive Care Unit instrument is being used (0%) and population assessed for delirium includes all adults over the age of 65, cognitive impairment, dementia, or both, current hip fracture and severe illness (0%). After the evidence-based practice implementation, the follow-up audit revealed up to 100% compliance rates with those criteria, showing that all patients under risk were screened and assessed for delirium. The only exception was the Confusion Assessment Method for the Intensive Care Unit use, whose compliance was observed in 80.95% of the medical records. CONCLUSION These findings support that baseline and follow-up audits allied to a delirium training program, and changes in the electronic nursing records increase the compliance rates related to the evidence-based practice for screening patients under risk and assessing delirium.
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Ji M, Wang J, Yang X, Huang Y, Xiao Y, Wu Y. Validation of the 3-minute diagnostic interview for CAM-defined Delirium in Chinese older adults. Geriatr Nurs 2020; 42:21-26. [PMID: 33197703 DOI: 10.1016/j.gerinurse.2020.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
Delirium is a common complication among older adults, but it is often unrecognized in routine practice. The 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) was developed to identify delirium in the general unit. This prospective diagnostic study was conducted to validate the accuracy of the 3D-CAM Chinese version among older adults in the general units. A total of 204 hospitalized older adults from a geriatric hospital were enrolled in the study, of whom 54 were identified as positive for delirium. The sensitivity and specificity of the 3D-CAM Chinese version were 94% and 97%, respectively. The median duration of assessment using the 3D-CAM was about 3 minutes. The 3D-CAM had highly acceptable sensitivity and specificity when it was used by nurse researchers among Chinese older adults.
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Affiliation(s)
- Meihua Ji
- School of Nursing, Capital Medical University, Beijing, China, 100069.
| | - Jiamin Wang
- School of Nursing, Capital Medical University, Beijing, China, 100069
| | - Xue Yang
- Beijing Hospital, Beijing, China, 100730
| | - Yongjun Huang
- Department of Neurology, Beijing Geriatric Hospital, Beijing, China, 100095
| | - Yanyan Xiao
- Peking University First Hospital, Beijing, China, 100034
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China, 100069.
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Association between cerebrospinal fluid biomarkers of neuronal injury or amyloidosis and cognitive decline after major surgery. Br J Anaesth 2020; 126:467-476. [PMID: 33183737 DOI: 10.1016/j.bja.2020.09.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Postoperative neurocognitive decline is a frequent complication in adult patients undergoing major surgery with increased risk for morbidity and mortality. The mechanisms behind cognitive decline after anaesthesia and surgery are not known. We studied the association between CSF and blood biomarkers of neuronal injury or brain amyloidosis and long-term changes in neurocognitive function. METHODS In patients undergoing major orthopaedic surgery (knee or hip replacement), blood and CSF samples were obtained before surgery and then at 4, 8, 24, 32, and 48 h after skin incision through an indwelling spinal catheter. CSF and blood concentrations of total tau (T-tau), neurofilament light, neurone-specific enolase and amyloid β (Aβ1-42) were measured. Neurocognitive function was assessed using the International Study of Postoperative Cognitive Dysfunction (ISPOCD) test battery 1-2 weeks before surgery, at discharge from the hospital (2-5 days after surgery), and at 3 months after surgery. RESULTS CSF and blood concentrations of T-tau, neurone-specific enolase, and Aβ1-42 increased after surgery. A similar increase in serum neurofilament light was seen with no overall changes in CSF concentrations. There were no differences between patients having a poor or good late postoperative neurocognitive outcome with respect to these biomarkers of neuronal injury and Aβ1-42. CONCLUSIONS The findings of the present explorative study showed that major orthopaedic surgery causes a release of CSF markers of neural injury and brain amyloidosis, suggesting neuronal damage or stress. We were unable to detect an association between the magnitude of biomarker changes and long-term postoperative neurocognitive dysfunction.
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Helfand BKI, D'Aquila ML, Tabloski P, Erickson K, Yue J, Fong TG, Hshieh TT, Metzger ED, Schmitt EM, Boudreaux ED, Inouye SK, Jones RN. Detecting Delirium: A Systematic Review of Identification Instruments for Non-ICU Settings. J Am Geriatr Soc 2020; 69:547-555. [PMID: 33135780 DOI: 10.1111/jgs.16879] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Delirium manifests clinically in varying ways across settings. More than 40 instruments currently exist for characterizing the different manifestations of delirium. We evaluated all delirium identification instruments according to their psychometric properties and frequency of citation in published research. DESIGN We conducted the systematic review by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Excerpta Medica Database (Embase), PsycINFO, PubMed, and Web of Science from January 1, 1974, to January 31, 2020, with the keywords "delirium" and "instruments," along with their known synonyms. We selected only systematic reviews, meta-analyses, or narrative literature reviews including multiple delirium identification instruments. MEASUREMENTS Two reviewers assessed the eligibility of articles and extracted data on all potential delirium identification instruments. Using the original publication on each instrument, the psychometric properties were examined using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) framework. RESULTS Of 2,542 articles identified, 75 met eligibility criteria, yielding 30 different delirium identification instruments. A count of citations was determined using Scopus for the original publication for each instrument. Each instrument underwent methodological quality review of psychometric properties using COSMIN definitions. An expert panel categorized key domains for delirium identification based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III through DSM-5. Four instruments were notable for having at least two of three of the following: citation count of 200 or more, strong validation methodology in their original publication, and fulfillment of DSM-5 criteria. These were, alphabetically, Confusion Assessment Method, Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98, and Memorial Delirium Assessment Scale. CONCLUSION Four commonly used and well-validated instruments can be recommended for clinical and research use. An important area for future investigation is to harmonize these measures to compare and combine studies on delirium.
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Affiliation(s)
- Benjamin K I Helfand
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Departments of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Madeline L D'Aquila
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia Tabloski
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Kristen Erickson
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Jirong Yue
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Tamara G Fong
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tammy T Hshieh
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Division of Gerontology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eran D Metzger
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eva M Schmitt
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sharon K Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard N Jones
- Departments of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study. Crit Care 2020; 24:609. [PMID: 33059749 PMCID: PMC7565834 DOI: 10.1186/s13054-020-03318-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. METHODS This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. RESULTS During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63-79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1-42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20-2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72-3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. CONCLUSION Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.
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MacLullich AM, Shenkin SD, Goodacre S, Godfrey M, Hanley J, Stíobhairt A, Lavender E, Boyd J, Stephen J, Weir C, MacRaild A, Steven J, Black P, Diernberger K, Hall P, Tieges Z, Fox C, Anand A, Young J, Siddiqi N, Gray A. The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study. Health Technol Assess 2020; 23:1-194. [PMID: 31397263 DOI: 10.3310/hta23400] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Delirium is a common and serious neuropsychiatric syndrome, usually triggered by illness or drugs. It remains underdetected. One reason for this is a lack of brief, pragmatic assessment tools. The 4 'A's test (Arousal, Attention, Abbreviated Mental Test - 4, Acute change) (4AT) is a screening tool designed for routine use. This project evaluated its usability, diagnostic accuracy and cost. METHODS Phase 1 - the usability of the 4AT in routine practice was measured with two surveys and two qualitative studies of health-care professionals, and a review of current clinical use of the 4AT as well as its presence in guidelines and reports. Phase 2 - the 4AT's diagnostic accuracy was assessed in newly admitted acute medical patients aged ≥ 70 years. Its performance was compared with that of the Confusion Assessment Method (CAM; a longer screening tool). The performance of individual 4AT test items was related to cognitive status, length of stay, new institutionalisation, mortality at 12 weeks and outcomes. The method used was a prospective, double-blind diagnostic test accuracy study in emergency departments or in acute general medical wards in three UK sites. Each patient underwent a reference standard delirium assessment and was also randomised to receive an assessment with either the 4AT (n = 421) or the CAM (n = 420). A health economics analysis was also conducted. RESULTS Phase 1 found evidence that delirium awareness is increasing, but also that there is a need for education on delirium in general and on the 4AT in particular. Most users reported that the 4AT was useful, and it was in widespread use both in the UK and beyond. No changes to the 4AT were considered necessary. Phase 2 involved 785 individuals who had data for analysis; their mean age was 81.4 (standard deviation 6.4) years, 45% were male, 99% were white and 9% had a known dementia diagnosis. The 4AT (n = 392) had an area under the receiver operating characteristic curve of 0.90. A positive 4AT score (> 3) had a specificity of 95% [95% confidence interval (CI) 92% to 97%] and a sensitivity of 76% (95% CI 61% to 87%) for reference standard delirium. The CAM (n = 382) had a specificity of 100% (95% CI 98% to 100%) and a sensitivity of 40% (95% CI 26% to 57%) in the subset of participants whom it was possible to assess using this. Patients with positive 4AT scores had longer lengths of stay (median 5 days, interquartile range 2.0-14.0 days) than did those with negative 4AT scores (median 2 days, interquartile range 1.0-6.0 days), and they had a higher 12-week mortality rate (16.1% and 9.2%, respectively). The estimated 12-week costs of an initial inpatient stay for patients with delirium were more than double the costs of an inpatient stay for patients without delirium (e.g. in Scotland, £7559, 95% CI £7362 to £7755, vs. £4215, 95% CI £4175 to £4254). The estimated cost of false-positive cases was £4653, of false-negative cases was £8956, and of a missed diagnosis was £2067. LIMITATIONS Patients were aged ≥ 70 years and were assessed soon after they were admitted, limiting generalisability. The treatment of patients in accordance with reference standard diagnosis limited the ability to assess comparative cost-effectiveness. CONCLUSIONS These findings support the use of the 4AT as a rapid delirium assessment instrument. The 4AT has acceptable diagnostic accuracy for acute older patients aged > 70 years. FUTURE WORK Further research should address the real-world implementation of delirium assessment. The 4AT should be tested in other populations. TRIAL REGISTRATION Current Controlled Trials ISRCTN53388093. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 40. See the NIHR Journals Library website for further project information. The funder specified that any new delirium assessment tool should be compared against the CAM, but had no other role in the study design or conduct of the study.
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Affiliation(s)
| | - Susan D Shenkin
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Steve Goodacre
- Emergency Medicine, University of Sheffield, Sheffield, UK
| | - Mary Godfrey
- Health and Social Care, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Janet Hanley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Antaine Stíobhairt
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Lavender
- Health and Social Care, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Allan MacRaild
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Jill Steven
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Polly Black
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Katharina Diernberger
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Peter Hall
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Zoë Tieges
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher Fox
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Atul Anand
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - John Young
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Najma Siddiqi
- Psychiatry, University of York, York.,Hull York Medical School, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Alasdair Gray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
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Abstract
Delirium is an acute confusional state that is common and costly and is associated with significant functional decline and distress. It is the manifestation of acute encephalopathy and is variably called acute brain failure, acute brain dysfunction, or altered mental status. All patients are at risk for delirium, although those with more vulnerabilities (such as advanced age, exposures to other stressors like infection, and certain medications) are at higher risk. The pathophysiologic cause of delirium is not well understood. It is important to recognize patients at risk for and those with delirium and to immediately identify and treat factors contributing to it. There is no single intervention or medication to treat delirium, making it challenging to manage. Therefore, risk mitigation and prompt treatment rely on a sophisticated strategy to address the contributing factors. Delirium may be prevented or attenuated when multimodal strategies are used, thereby improving patient outcomes.
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Affiliation(s)
- Melissa L P Mattison
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (M.L.M.)
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48
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Patrono D, Rigo F, Bormida S, Berchialla P, Giordanengo L, Skurzak S, Balagna R, Romagnoli R. Graft factors as determinants of postoperative delirium after liver transplantation. Updates Surg 2020; 72:1053-1063. [PMID: 32974861 PMCID: PMC7680746 DOI: 10.1007/s13304-020-00887-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/07/2020] [Indexed: 12/29/2022]
Abstract
Post-operative delirium (POD) is a frequent complication after surgery, occurring in 15-20% of patients. POD is associated with a higher complications rate and mortality. Literature on POD after liver transplantation (LT) is limited, with the few available studies reporting an incidence of 10-47%. The aim of this study was analyzing pattern, risk factors and clinical impact of POD after LT. Data on donor and recipient characteristics, postoperative course and POD of consecutive adult LT recipients from March 2016 to May 2018 were prospectively collected and retrospectively analyzed. Risk factors for POD were analyzed using univariable logistic regression and Lasso regression. Kaplan-Meier method was used for survival analysis. 309 patients underwent LT during study period; 3 were excluded due to perioperative death. Incidence of POD was 13.4% (n = 41). The median day of onset was 5th (IQR [4-7]) with a median duration of 4 days (IQR [3-7]). Several risk factors, related to the severity of liver disease and graft characteristics, were identified. Graft macrovesicular steatosis was the only factor independently associated with POD at multivariable analysis (OR 1.27, CI 1.09-1.51, p = 0.003). POD was associated with a higher rate of severe postoperative complications and longer intensive care unit and hospital stay, but did not significantly impact on patient and graft survival. Incidence of POD after LT is comparable to that observed after general surgery and graft factors are strongly associated with its onset. These results help identifying a subset of patients to be considered for preventive interventions.
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Affiliation(s)
- D Patrono
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88-90, 10126, Turin, Italy
| | - F Rigo
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88-90, 10126, Turin, Italy
| | - S Bormida
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88-90, 10126, Turin, Italy
| | - P Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - L Giordanengo
- Regional Transplant Center, Unit of Medical Psychology for Transplantation, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - S Skurzak
- Anesthesia and Intensive Care Service 2, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - R Balagna
- Anesthesia and Intensive Care Service 2, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - R Romagnoli
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88-90, 10126, Turin, Italy.
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49
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Chouët J, Sacco G, Karras SN, Llewellyn DJ, Sánchez-Rodríguez D, Annweiler C. Vitamin D and Delirium in Older Adults: A Case-Control Study in Geriatric Acute Care Unit. Front Neurol 2020; 11:1034. [PMID: 33071932 PMCID: PMC7533565 DOI: 10.3389/fneur.2020.01034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/10/2020] [Indexed: 12/29/2022] Open
Abstract
Objective: Vitamin D is involved in brain health and function. Our objective was to determine whether the serum 25-hydroxyvitamin D (25OHD) concentration was associated with delirium in a case-control study of geriatric inpatients. Methods: Sixty cases with delirium (mean ± SD, 84.8 ± 5.7years; 58.3% female) and 180 age- and gender-matched controls were enrolled in a geriatric acute care unit between 2012 and 2014. The diagnosis of delirium was made using the Confusion Assessment Method. Hypovitaminosis D was defined using consecutively the consensual threshold value of 50 nmol/L and a threshold value calculated from a sensitivity-specificity analysis. Age, gender, number of acute diseases, use of psychoactive drugs, season of testing, and serum concentrations of calcium, parathyroid hormone, creatinine, albumin, TSH, vitamin B9 and vitamin B12 were used as potential confounders. Results: The 60 cases with delirium exhibited lower 25OHD concentration than 180 matched controls (35.4 ± 30.0 nmol/L vs. 45.9 ± 34.5 nmol/L, p = 0.035). Increased 25OHD concentration was associated with a decrease in delirium prevalence (OR = 0.99 [95CI: 0.98–0.99] per nmol/L of 25OHD, p = 0.038). The concentration distinguishing between cases and controls with the best sensitivity-specificity was found between 29.5 and 30.5 nmol/L. The regression models showed that delirium was associated with hypovitaminosis D defined either as 25OHD ≤ 50 nmol/L (OR = 2.37 [95CI: 1.07–5.25], p = 0.034) or as 25OHD ≤ 30 nmol/L (OR = 2.66 [95 CI: 1.30–5.45], p = 0.008). Conclusions: Decreased serum 25OHD concentrations were associated with delirium among acute geriatric inpatients. The threshold concentration to differentiate between cases and controls was around 30 nmol/L.
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Affiliation(s)
- Justine Chouët
- Department of Geriatric Medicine, Cholet Hospital, Cholet, France.,Department of Geriatric Medicine, Angers University Memory Clinic, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
| | - Guillaume Sacco
- Department of Geriatric Medicine, Angers University Memory Clinic, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France.,UPRES EA 4638 and Health Faculty, University of Angers, Angers, France
| | - Spyridon N Karras
- Division of Endocrinology and Metabolism, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Dolores Sánchez-Rodríguez
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
| | - Cédric Annweiler
- Department of Geriatric Medicine, Angers University Memory Clinic, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France.,UPRES EA 4638 and Health Faculty, University of Angers, Angers, France.,Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON, Canada
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50
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Jeong E, Park J, Lee J. Diagnostic test accuracy of the Nursing Delirium Screening Scale: A systematic review and meta‐analysis. J Adv Nurs 2020; 76:2510-2521. [DOI: 10.1111/jan.14482] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/18/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Eunhye Jeong
- College of Nursing Korea University Seoul Republic of Korea
| | - Jinkyung Park
- College of Nursing Korea University Seoul Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics College of Medicine Korea University Seoul Republic of Korea
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