Hyperactive delirium during emergency department stay : analysis of risk factors and association with short-term outcomes
Miró, Oscar (Hospital Clínic i Provincial de Barcelona)
Osorio, Georgina I. (Hospital Clínic i Provincial de Barcelona)
Alquézar-Arbé, A. (Institut de Recerca Sant Pau)
Aguiló, Sira (Hospital Clínic i Provincial de Barcelona)
Fernández Alonso, Cesáreo (Hospital Clínico San Carlos (Madrid))
Burillo-Putze, Guillermo (Hospital Universitario de Canarias (La Laguna))
Jacob, Javier (Hospital Universitari de Bellvitge)
Llorens Soriano, Pere (Hospital General Universitario de Alicante (Alacant, País Valencià))
Llauger, Lluis (Hospital Universitari de Vic)
Peláez González, Ángel (Hospital del Nalón (Llangréu, Astúries))
Figuera Castro, Edmundo Ramón (Hospital Altagracia (Manzanares, Madrid))
Juarez-González, Ricardo (Hospital Nuestra Señora del Prado de Talavera de La Reina (Toledo))
Blanco Hoffman, María José (Hospital Universitario Vinalopó (Alacant))
Fernandez Salgado, Fátima (Hospital de Móstoles (Madrid))
Pablos Pizarro, Teresa (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Berenguer Díez, María Amparo (Hospital General Universitario Dr. Peset (València))
Truyol Más, Marina (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
López-Laguna, Nieves (Clinica Universitaria Navarra (Madrid))
Garcia Acosta, Jacinto (Hospital Clínic Universitari (València))
Fernandez Domato, Carmen (Hospital Álvaro Cunqueiro (Vigo))
Diego Robledo, Francisco Javier (Hospital Universitario de Salamanca)
Ezponda, Patxi (Hospital de Zumárraga (Guipúscoa, País Basc)))
Martinez Lorenzo, Andrea (Hospital Virxe da Xunqueira)
Ortega Liarte, Juan Vicente (Hospital Universitario Los Arcos del Mar Menor)
García Rupérez, Inmaculada (Hospital Universitario Río Ortega (Valladolid, Castella i LLeó))
Borne Jerez, Setefilla (Hospital Juan Ramón Jiménez (Huelva, Andalusia))
Corugedo Ovies, Claudia (Hospital Universitario Central de Asturias)
Gallardo Sánchez, Blanca Andrea (Hospital Clínico San Carlos (Madrid))
González del Castillo, Juan (Hospital Clínico San Carlos (Madrid))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1. 6%). Delirium was directly associated with previous episodes of delirium (OR: 2. 44, 95% CI 1. 24-4. 82), transfer to the ED observation unit (1. 62, 1. 23-2. 15), chronic treatment with opiates (1. 51, 1. 09-2. 09) and length of ED stay longer than 12 h (1. 41, 1. 02-1. 97) and was indirectly associated with chronic kidney disease (0. 60, 0. 37-0. 97). The 30-day all-cause mortality was 4. 0% in delirium group and 2. 9% in non-delirium group (OR: 1. 52, 95% CI 0. 83-2. 78), need for hospitalization 25. 6% and 25% (1. 09, 0. 83-1. 43), in-hospital mortality 16. 4% and 7. 3% (2. 32, 1. 24-4. 35), prolonged hospitalization 54. 5% and 48. 6% (1. 27, 0. 80-2. 00), respectively, and 90-day post-discharge combined adverse event 36. 4% and 35. 8%, respectively (1. 06, 0. 82-2. 00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Benzodiazepines ; Delirium ; Emergency department ; Mortality ; Neuroleptics ; Outcome
Publicat a:	Internal and Emergency Medicine, 2023 , ISSN 1970-9366

DOI: 10.1007/s11739-023-03440-3
PMID: 37865623

11 p, 1.1 MB

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