Review finds lack of delirium screening in the emergency department

Delirium in older patients in an emergency room setting can foretell other health issues. But according to a new study published in the Annals of Emergency Medicine, the condition is frequently overlooked because of a lack of screening tools in emergency departments.

An estimated one in 10 seen in hospital departments in the United States experiences delirium, but this acute change in is often not recognized. Researchers from the Regenstrief Institute and Indiana University conducted a systematic review of existing studies on delirium in emergency departments and found that neither completely validated delirium screening instruments nor an ideal schedule to perform delirium assessments exist there.

The emergency department is a unique environment with significant time pressure challenges. Emergency department physicians typically don't have long-term relationships with patients; they are often unaware of patients' baseline mental status as the health care team tends to the emergency.

"Fewer than a third of older adults with delirium in the ED are being recognized, and we need to improve that detection rate," said Regenstrief Institute investigator Michael A. LaMantia, M.D., MPH, who led the systemic review of delirium screening. "Patients sent home from the ED with undetected delirium have six-month mortality rates almost three times greater than their counterparts in whom delirium is detected. Unrecognized delirium presents a major health challenge to older adults and an increased burden on the health care system.

"Patients with delirium will have hospital stays that are more than twice as long—21 versus nine days," said Dr. LaMantia, who is also an IU Center for Aging Research scientist and assistant professor of medicine at IU School of Medicine. "They will also have a greater probability of being discharged from the hospital to a long-term-care facility and a much higher probability of developing dementia than individuals who do not experience delirium."

Delirium is a state of confusion that can develop suddenly and usually goes away in days to weeks if treated properly, according to the American Delirium Society. The society estimates that more than 7 million hospitalized Americans experience annually.

Dr. LaMantia, who is a geriatrician, said further work is needed to develop and validate emergency department-specific screening instruments and to determine how often to administer screenings in the rapid-paced environment. He also encourages those accompanying an older adult to the to serve as patient advocates by passing along baseline mental status information.

"The ED doctor is unaware of what the person looks like in daily life," he said. "They aren't seeing a complete set of colors. A family member or friend can help fill in the colors and gradations of colors. Nothing can replace having someone who knows the patient telling you that person's baseline."

More information: "Screening for Delirium in the Emergency Department: A Systematic Review" has been published online in advance of publication in the Annals of Emergency Medicine.

add to favorites email to friend print save as pdf

Related Stories

Team finds first biomarker linked to delirium duration

Dec 16, 2013

Researchers from the Regenstrief Institute and the Indiana University Center for Aging Research have identified the first biomarker that appears to be linked to the duration of delirium. This novel role for S100ß as a biomarker ...

High rate of early delirium after surgery in older adults

Jul 24, 2013

Close to half of older adults undergoing surgery with general anesthesia are found to have delirium in the postanesthesia care unit (PACU), according to a study in the August issue of Anesthesia & Analgesia, official journa ...

Protecting our brains: Tackling delirium

Nov 17, 2011

A new national plan of action provides a roadmap for improving the care of patients with delirium, a poorly understood and often unrecognized brain condition that affects approximately seven million hospitalized Americans ...

Recommended for you

Sensors may keep hospitalized patients from falling

4 hours ago

(Medical Xpress)—To keep hospitalized patients safer, University of Arizona researchers are working on new technology that involves a small, wearable sensor that measures a patient's activity, heart rate, ...

Rising role seen for health education specialists

6 hours ago

(HealthDay)—A health education specialist can help family practices implement quality improvement projects with limited additional financial resources, according to an article published in the March/April ...

FDA proposes first regulations for e-cigarettes (Update)

7 hours ago

The U.S. government wants to ban sales of electronic cigarettes to minors and require approval for new products and health warning labels under regulations being proposed by the federal Food and Drug Administration.

User comments