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Prevalence and detection of delirium in elderly emergency department patients.
CMAJ. 2000 Oct 17; 163(8):977-81.CMAJ

Abstract

BACKGROUND

Delirium is a complex medical disorder associated with high morbidity and mortality among elderly patients. The goals of our study were to determine the prevalence of delirium in emergency department (ED) patients aged 65 years and over and to determine the sensitivity and specificity of a conventional clinical assessment by an ED physician for the detection of delirium in the same population.

METHODS

All elderly patients presenting to the ED in a primary acute care, university-affiliated hospital who were triaged to the observation room on a stretcher because of the severity of their illness were screened for delirium by a research psychiatrist using the Mini-Mental State Examination and the Confusion Assessment Method. The diagnosis of "delirium" or an equivalent term by the ED physician was determined by 2 methods: completion of a mental status checklist by the ED physician and chart review. The prevalence of delirium and the sensitivity and specificity of the ED physician's clinical assessment were calculated with their 95% confidence intervals. The demographic and clinical characteristics of patients with detected delirium and those with undetected delirium were compared.

RESULTS

A sample of 447 patients was screened. The prevalence of delirium was 9.6% (95% confidence interval 6.9%-12.4%). The sensitivity of the detection of delirium by the ED physician was 35.3% and the specificity, 98.5%. Most patients with delirium had neurologic or pulmonary diseases, and most patients with detected delirium had neurologic diseases.

INTERPRETATION

Despite the relatively high prevalence of delirium in elderly ED patients, the sensitivity of a conventional clinical assessment for this condition is low. There is a need to improve the detection of delirium by ED physicians.

Authors+Show Affiliations

Department of Psychiatry, McGill University, Montreal, Que. geriatricpsych@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11068569

Citation

Elie, M, et al. "Prevalence and Detection of Delirium in Elderly Emergency Department Patients." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 163, no. 8, 2000, pp. 977-81.
Elie M, Rousseau F, Cole M, et al. Prevalence and detection of delirium in elderly emergency department patients. CMAJ. 2000;163(8):977-81.
Elie, M., Rousseau, F., Cole, M., Primeau, F., McCusker, J., & Bellavance, F. (2000). Prevalence and detection of delirium in elderly emergency department patients. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 163(8), 977-81.
Elie M, et al. Prevalence and Detection of Delirium in Elderly Emergency Department Patients. CMAJ. 2000 Oct 17;163(8):977-81. PubMed PMID: 11068569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and detection of delirium in elderly emergency department patients. AU - Elie,M, AU - Rousseau,F, AU - Cole,M, AU - Primeau,F, AU - McCusker,J, AU - Bellavance,F, PY - 2000/11/9/pubmed PY - 2001/2/28/medline PY - 2000/11/9/entrez SP - 977 EP - 81 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 163 IS - 8 N2 - BACKGROUND: Delirium is a complex medical disorder associated with high morbidity and mortality among elderly patients. The goals of our study were to determine the prevalence of delirium in emergency department (ED) patients aged 65 years and over and to determine the sensitivity and specificity of a conventional clinical assessment by an ED physician for the detection of delirium in the same population. METHODS: All elderly patients presenting to the ED in a primary acute care, university-affiliated hospital who were triaged to the observation room on a stretcher because of the severity of their illness were screened for delirium by a research psychiatrist using the Mini-Mental State Examination and the Confusion Assessment Method. The diagnosis of "delirium" or an equivalent term by the ED physician was determined by 2 methods: completion of a mental status checklist by the ED physician and chart review. The prevalence of delirium and the sensitivity and specificity of the ED physician's clinical assessment were calculated with their 95% confidence intervals. The demographic and clinical characteristics of patients with detected delirium and those with undetected delirium were compared. RESULTS: A sample of 447 patients was screened. The prevalence of delirium was 9.6% (95% confidence interval 6.9%-12.4%). The sensitivity of the detection of delirium by the ED physician was 35.3% and the specificity, 98.5%. Most patients with delirium had neurologic or pulmonary diseases, and most patients with detected delirium had neurologic diseases. INTERPRETATION: Despite the relatively high prevalence of delirium in elderly ED patients, the sensitivity of a conventional clinical assessment for this condition is low. There is a need to improve the detection of delirium by ED physicians. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/11068569/Prevalence_and_detection_of_delirium_in_elderly_emergency_department_patients_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=11068569 DB - PRIME DP - Unbound Medicine ER -