Review finds lack of delirium screening in the emergency department

January 14, 2014

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."

Explore further: Team finds first biomarker linked to delirium duration

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.

Related Stories

Team finds first biomarker linked to delirium duration

December 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 ...

Hospital study finds connection between dementia, delirium and declining health

September 16, 2013
More than half of all patients with pre-existing dementia will experience delirium while hospitalized. Failing to detect and treat their delirium early leads to a faster decline of both their physical and mental health, according ...

High rate of early delirium after surgery in older adults

July 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 journal ...

Study provides roadmap for delirium risks, prevention, treatment, prognosis and research

September 18, 2012
Delirium, a common acute condition with significant short- and long-term effects on cognition and function, should be identified as an indicator of poor long-term prognosis, prompting immediate and effective management strategies, ...

Protecting our brains: Tackling delirium

November 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 ...

Commonly used drug does not reduce delirium in critically ill patients

August 20, 2013
Delirium, or severe confusion and disorientation, is often experienced by critically ill patients, and although causality between delirium and mortality is not established, critically ill patients who develop delirium are ...

Recommended for you

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

Safety of medical devices not often evaluated by sex, age, or race

July 25, 2017
Researchers at Yale and the University of California-San Francisco have found that few medical devices are analyzed to consider the influence of their users' sex, age, or race on safety and effectiveness.

Why you should consider more than looks when choosing a fitness tracker

July 25, 2017
A UNSW study of five popular physical activity monitors, including Fitbit and Jawbone models, has found their accuracy differs with the speed of activity, and where they are worn.

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.