scholarly journals Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: a prospective cohort study

2021 ◽  
Author(s):  
Marius Myrstad ◽  
Kanika Kuwelker ◽  
Sigurd Haakonsen ◽  
Therese Valebjørg ◽  
Nina Langeland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Screening Tool ◽  
Suspected Sepsis ◽  
Sepsis Diagnosis ◽  
The Mean ◽  
Diagnosis Criteria

Abstract Purpose We aimed to study the use of The 4 ‘A’s test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). Out of the 100 patients with sepsis, 68 (68%) had delirium during the hospital stay, as compared to 34 out of 96 patients (35%) without sepsis (p < 0.05). Conclusion Delirium screening upon ED admission, using 4AT, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. The prevalence of delirium during the hospital stay was high, particularly in patients with sepsis. Graphic abstract

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

2021 ◽  
Author(s):  
Marius Myrstad ◽  
Kanika Kuwelker ◽  
Sigurd Haakonsen ◽  
Therese Valebjørg ◽  
Bård Reiakvam Kittang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Older Patients ◽  
Added Value ◽  
Suspected Sepsis ◽  
Diagnosis Criteria

Abstract Background Cognitive impairment is common among acutely ill older patients admitted to hospital. The quick Sequential Organ Failure Assessment (qSOFA) is recommended as a tool to predict poor outcome in patients with suspected sepsis, but assesses cognitive function crudely. We aimed to study the feasibility of The 4 'A's test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission by nurses and doctors inexperienced with this tool, and to characterize patients aged ≥ 65 years admitted to the ED with suspected sepsis. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the EDs of two Norwegian general hospitals, with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years), 100 patients fulfilled the sepsis diagnosis criteria. Mean 4AT screening time was 2.5 minutes (median two minutes). While qSOFA identified 48 patients (24%) with altered mental status, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). The prevalence of delirium any time during the hospital stay was 44% in patients aged 65–80 years, 57% in patients aged ≥ 80 years, and 76% in patients aged ≥ 80 years with sepsis. Conclusions Delirium screening upon ED admission, with 4AT performed by nurses and doctors inexperienced with this tool, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Features of delirium were common upon ED admission, particularly in patients with sepsis. The prevalence of delirium anytime during the hospital stay was highest among patients aged 80 years and older with sepsis. Our findings suggest increased awareness of delirium in older patients admitted to the ED with suspected sepsis, but the added value of systematic delirium screening with 4AT needs to be addressed in future studies.

scholarly journals Prognostic Value of Nucleated RBCs for Patients With Suspected Sepsis in the Emergency Department: A Single-Center Prospective Cohort Study

2021 ◽  
Vol 3 (7) ◽  
pp. e0490
Author(s):  
Erik K. Amundsen ◽  
Christina Binde ◽  
Erik E. Christensen ◽  
Olav Klingenberg ◽  
Dag Kvale ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Prognostic Value ◽  
Single Center ◽  
Suspected Sepsis

Development of the Sydney Falls Risk Screening Tool in brain injury rehabilitation: A multisite prospective cohort study

2018 ◽  
Vol 27 (5-6) ◽  
pp. 958-968 ◽  
Author(s):  
Duncan McKechnie ◽  
Murray J Fisher ◽  
Julie Pryor ◽  
Melissa Bonser ◽  
Jhoven De Jesus
Keyword(s):  
Cohort Study ◽  
Brain Injury ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Screening Tool ◽  
Risk Screening ◽  
Injury Rehabilitation ◽  
Falls Risk

Preventable hospitalizations among older patients with cognitive impairments and dementia

2018 ◽  
Vol 31 (3) ◽  
pp. 383-391 ◽  
Author(s):  
Dominik Wolf ◽  
Carolin Rhein ◽  
Katharina Geschke ◽  
Andreas Fellgiebel
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Ambulatory Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Older Patients ◽  
Hospital Admissions ◽  
Cognitive Impairments ◽  
Length Of Hospital Stay ◽  
Complication Rates

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

scholarly journals Cost of Living with Parkinson’s Disease over 12 Months in Australia: A Prospective Cohort Study

2017 ◽  
Vol 2017 ◽  
pp. 1-13 ◽  
Author(s):  
Shalika Bohingamu Mudiyanselage ◽  
Jennifer J. Watts ◽  
Julie Abimanyi-Ochom ◽  
Lisa Lane ◽  
Anna T. Murphy ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health System ◽  
Prospective Cohort Study ◽  
Resource Use ◽  
Prospective Cohort ◽  
Annual Cost ◽  
Severe Disease ◽  
Medicare Data ◽  
The Mean

Background. Parkinson disease (PD) is a costly chronic condition in terms of managing both motor and nonmotor symptoms. The burden of disease is high for individuals, caregivers, and the health system. The aim of this study is to estimate the annual cost of PD from the household, health system, and societal perspectives. Methods. A prospective cohort study of newly referred people with PD to a specialist PD clinic in Melbourne, Australia. Participants completed baseline and monthly health resource use questionnaires and Medicare data were collected over 12 months. Results. 87 patients completed the 12-month follow-up assessments. The mean annual cost per person to the health care system was $32,556 AUD. The burden to society was an additional $45,000 per annum per person with PD. The largest component of health system costs were for hospitalisation (69% of total costs). The costs for people with moderate to severe disease were almost 4 times those with mild PD ($63,569 versus $17,537 p<0.001). Conclusion. PD is associated with significant costs to individuals and to society. Costs escalated with disease severity suggesting that the burden to society is likely to grow with the increasing disease prevalence that is associated with population ageing.

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