Abstract 1122‐000208: Imaging Characteristics for Post Stroke Delirium

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohammad Jamil Ahmad ◽  
Sahar Anjum ◽  
Aditya Kumar ◽  
Jacob Sebaugh ◽  
Michele Joseph ◽  
...  
Keyword(s):  
Infarct Size ◽  
Hospital Stay ◽  
Hospital Admissions ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Post Stroke ◽  
Imaging Characteristics ◽  
Patients At Risk ◽  
A Prospective Study ◽  
Expected Mortality

Introduction : Delirium after acute ischemic stroke (AIS) is a common clinical occurrence, present in 13–48% of patients. Post‐stroke delirium is associated with longer hospital admissions, worse functional outcomes, and increased mortality in the short term and has been associated with worse long‐term outcomes. Prior studies have shown right‐sided strokes are more associated with delirium, but very few other imaging characteristics of post‐stroke delirium have been described. We conducted a prospective study evaluating imaging characteristics for patients with delirium. Methods : Between Sept 2019 and June 2021, patients diagnosed with AIS within 48 hrs of stroke onset were prospectively evaluated for delirium using the Confusion Assessment Method (CAM)‐ICU daily for the first eight days of their hospital stay. Patients with severe stroke and expected mortality within the first month at the time of admission or with severe aphasia unable to follow commands were excluded. Data regarding demographics, comorbidities, hospital stay, stroke metrics, lab work and medications were analyzed. Imaging characteristics were adjudicated by authors based on either the patient’s first MRI or the 24 hr CT after admission. Infarct size measured based on ABC/2 formula based on diffusion‐weighted imaging on MRI or stroke appearance on CT. Results : Over the course of 12 non‐consecutive months, we evaluated 213 patients, of which 177 could be assessed with the CAM‐ICU. Delirium was present in 88 (49.7%). There were no statistically significant differences in age, gender, race, co‐morbidities, or TOAST etiology among patients with and without delirium (Table 1). Patients with delirium had higher NIHSS and were more likely to receive tPA. Patients with delirium were more likely to have MCA territory strokes, strokes involving the insula, and to have infarct sizes ≥10 cc. On multivariate modeling, NIHSS (OR 1.07; 95% CI 1.01, 1.13), MCA territory stroke (OR 2.62; 95% CI 1.09, 6.30), and infarct size ≥10 cc (OR 3.23; 95% CI 1.46, 6.90) were associated with delirium. Conclusions : In a cohort of AIS patients without significant expected mortality on admission, the incidence of delirium is high. On evaluation, infarct size ≥10 cc and in the MCA territory were more associated with delirium than NIHSS. These imaging characteristics should be considered in any future predictive models for identifying patients at risk for delirium.

54 No One Told Me I Couldn’t Drive with Delirium

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Watson ◽  
L Ralston
Keyword(s):  
Screening Tool ◽  
Hospital Admissions ◽  
District General Hospital ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Lead Author ◽  
Common Cause ◽  
Confusion Assessment ◽  
Number Of Patients ◽  
Patients At Risk

Abstract Introduction Delirium is a common cause and complication of hospital admissions. DVLA1, and Consensus guidelines2 exist for driving with dementia or mild cognitive impairment, but there are no specific guidelines pertaining to delirium. This audit set out to find the prevalence of delirium in a district general hospital prior to implementation of a standard screening tool. It was noteworthy that a significant number of patients with delirium were drivers. Methods The notes of 114 patients under the care of nine specialties, both medical and surgical were prospectively reviewed. Of those with risk factors for delirium, data was collected on the number of patients who had a diagnosis of delirium made during their admission. For patients at risk with no documented screening already completed a Confusion Assessment Method (CAM) screening test was performed by the lead author. In patients identified with delirium it was also established if they were current drivers via clerking documentation or by discussion with the patient/family. Drivers with delirium were highlighted in the medical notes and where possible discussions were had with the patient and their families regarding driving advice until the delirium had resolved. Results The prevalence of delirium in this group was 23% (n = 26/114). 20 patients had documented evidence of delirium and a further 6 patients were diagnosed as a result of this project. 15.4% (n = 4/26) of patients with delirium were current drivers. For this group there was no documented evidence that driving advice had been given to the patient or family. Conclusion This baseline audit has identified that delirium is not consistently screened for and identified. In patients with delirium, driving history is not being sought and consequently the opportunity for driving advice is being missed. Clear guidance from the DVLA on driving for patients with a resolving delirium is needed. References 1. DVLA, 2018. 2. RCPsych, 2019.

Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium

2010 ◽  
Vol 23 (4) ◽  
pp. 602-608 ◽  
Author(s):  
Jane McCusker ◽  
Martin G. Cole ◽  
Philippe Voyer ◽  
Johanne Monette ◽  
Nathalie Champoux ◽  
...  
Keyword(s):  
Long Term Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Composite Outcome ◽  
Term Care ◽  
Relative Risks ◽  
Low Sensitivity ◽  
A Prospective Study

ABSTRACTBackground: Previous studies have reported that nurse detection of delirium has low sensitivity compared to a research diagnosis. As yet, no study has examined the use of nurse-observed delirium symptoms combined with research-observed delirium symptoms to diagnose delirium. Our specific aims were: (1) to describe the effect of using nurse-observed symptoms on the prevalence of delirium symptoms and diagnoses in long-term care (LTC) facilities, and (2) to compare the predictive validity of delirium diagnoses based on the use of research-observed symptoms alone with those based on research-observed and nurse-observed symptoms.Methods: Residents aged 65 years and over of seven LTC facilities were recruited into a prospective study. Using the Confusion Assessment Method (CAM), research assistants (RAs) interviewed residents and nurses to assess delirium symptoms. Delirium symptoms were also abstracted independently from nursing notes. Outcomes measured at five month follow-up were: death, the Hierarchic Dementia Scale (HDS), the Barthel ADL scale, and a composite outcome measure (death, or a 10-point decline in either the HDS or the ADL score).Results: The prevalence of delirium among 235 LTC residents increased from 14.0% (using research-observed symptoms only) to 24.7% (using research- and nurse-observed symptoms). The relative risks (and 95% confidence intervals) for prediction of the composite outcome, after adjustment for covariates, were: 1.43 (0.88, 1.96) for delirium using research-observed symptoms only; 1.77 (1.13, 2.28) for delirium using research- and nurse-observed symptoms, in comparison with no delirium.Conclusions: The inclusion of delirium symptoms observed by nurses not only increases the detection of delirium in LTC facilities but improves the prediction of outcomes.

scholarly journals A study of etiological profile of acute confusional state

2019 ◽  
Vol 7 (1) ◽  
pp. 138
Author(s):  
Jaspreet Kaur ◽  
Gurinder Mohan ◽  
S. B. Nayyar ◽  
Ranjeet Kaur
Keyword(s):  
Hospital Stay ◽  
The Elderly ◽  
Final Diagnosis ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Acute Confusional State ◽  
Provisional Diagnosis ◽  
Metabolic Encephalopathy ◽  
Common Diagnosis ◽  
One Year

Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77±18.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6±3.67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.

scholarly journals Mannitol Is Associated with Less Postoperative Delirium after Aortic Valve Surgery in Patients Treated with Bretschneider Cardioplegia

2020 ◽  
Author(s):  
Marwan Hamiko ◽  
Efstratios I. Charitos ◽  
Markus Velten ◽  
Tobias Hilbert ◽  
Christian Putensen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hospital Stay ◽  
Postoperative Delirium ◽  
Heart Surgery ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Confusion Assessment Method ◽  
Simplified Acute Physiology Score ◽  
Assessment Method ◽  
Ventilation Time

Abstract Background Heart surgery with extracorporeal circulation (ECC) often leads to postoperative delirium (POD). This is associated with increased morbidity resulting in longer hospital stay and associated costs. The purpose of our study was to analyze the effect of intraoperative mannitol application on POD in patients undergoing elective aortic valve replacement (AVR). Materials and Methods In our retrospective single-center study, 259 patients underwent elective AVR, using Bretschneider cardioplegic solution for cardiac arrest, between 2014 and 2017. Patients were divided in mannitol (n = 188) and nonmannitol (n = 71) groups. POD was assessed using the confusion assessment method for the intensive care unit (ICU). Statistical significance was assumed at p < 0.05. Results Baseline patient characteristics did not differ between the groups. Incidence of POD was significantly higher in the nonmannitol group (33.8 vs. 13.8%; p = 0.001). These patients required longer ventilation time (24.1 vs. 17.1 hours; p = 0.021), higher reintubation rate (11.3 vs. 2.7%; p = 0.009), ICU readmission (12.7 vs. 4.8%; p = 0.026), prolonged ICU (112 vs. 70 hours; p = 0.040), and hospital stay (17.8 vs. 12.6 days; p < 0.001), leading to higher expenses (19,349 € vs. 16,606 €, p < 0.001). A 30-day mortality was not affected, but nonmannitol group showed higher Simplified Acute Physiology Score II score (32.2 vs. 28.7; p < 0.001). Mannitol substitution was independently associated with lower incidence of POD (odds ratio: 0.40; 95% confidence interval: 0.18–0.89; p = 0.02). Conclusion Treatment with mannitol during ECC was associated with decreased incidence of POD. This was accompanied by shorter ventilation time, ICU and hospital stay, and lower treatment expenses.

Abstract T P304: Disordered Attention May Persist After Resolution of Post-Stroke Delirium

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Eric M Liotta ◽  
Carlos Corado ◽  
Deborah L Bergman ◽  
Richard A Bernstein ◽  
Fan Z Caprio ◽  
...  
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Patient Reported Outcome ◽  
Linear Regression Models ◽  
Lower Extremity Function ◽  
Post Stroke ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related ◽  
Outcome Tool

Introduction: Delirium after acute stroke has been associated with worse outcomes but the effect on domain specific health-related quality of life (QOL) is less well-defined. We hypothesized that post-stroke delirium is associated with worse QOL. Methods: A prospective cohort of acute ischemic stroke patients was screened for post-stroke delirium. Delirium was diagnosed using the Confusion Assessment Method. Patient variables were prospectively recorded including initial NIHSS score and medical complications. Six QOL domains were assessed at three months post-stroke using Neuro-QOL (a validated patient-reported outcome tool that calculates T scores with means of 50 and standard deviations of 10): upper and lower extremity function, social roles satisfaction, fatigue, executive function (planning, calculating, and learning), and general cognitive concerns ([GCC] perceived attention, memory, and decision difficulties). Functional outcomes at 3 months were also obtained using the modified Rankin Scale (mRS, a validated outcome measure from 0, no symptoms, to 6, death). Univariate associations between delirium and QOL domains were identified and linear regression models were developed for domains with significant associations. Results: Over 10 months 246 patients (56% male, mean 65 years) met inclusion criteria. Delirium occurred in 30 (12%) patients. Three month follow up exceeded 90%. Of the Neuro-QOL domains, only GCC was significantly different between those with delirium and those without (T-scores 48.6 vs. 53.4, p=0.03). The mRS outcomes did not differ between those with delirium and those without (median [interquartile range], 1 [0-3] vs 1 [0-2]; p=0.59). Delirium (Beta -3.8, p=0.02) and initial NIHSS (Beta -0.25, p=0.006) were associated with worse GCC after correction for covariates. Conclusion: Our finding that post-stroke delirium is independently associated with worse measures of cognition at three months suggests that the disordered attention of delirium may persist long term. Delirium may impair recovery after stroke or may represent a separate mechanism of neurologic injury not well characterized by global outcome scales like the mRS.

scholarly journals MP30: Validation of the 4AT questionnaire in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S75
Author(s):  
A. Gagné ◽  
P. Voyer ◽  
V. Boucher ◽  
M. Pelletier ◽  
E. Gouin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cognitive Impairment ◽  
Telephone Interview ◽  
Rapid Assessment ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Status ◽  
French Version ◽  
Elderly Inpatients ◽  
Patients At Risk

Introduction: Delirium is a very prevalent cognitive impairment in elderly inpatients, but it often goes undetected, especially in the emergency department (ED). The tools currently available to screen or diagnose patients at risk of delirium are very time-consuming and are impossible to systematically perform in the ED environment. For this reason, short tests are necessary to screen for delirium in this fast-paced setting. The objective of this study was to evaluate the performance of the French version of the Rapid Assessment Test for Delirium (4AT) for the detection of delirium and cognitive impairment in older patients. The 4AT takes less than 2 minutes to administer, which is a great advantage on the others tests. Methods: The study was conducted in four emergency departments across the province of Québec. Participants were independent or semi-independent patients aged 65 and older, admitted to hospital and who had an 8-hour exposure to the ED. The Telephone Interview for Cognitive Status (TICS) was administered at the initial interview and the Confusion Assessment Method (CAM) as well as the 4AT were administered to patients twice a day during their ED or hospital stay. The 4AT’s sensitivity and specificity were compared to that of the CAM (for delirium), and to that of the TICS (for cognitive impairment). Results: 324 patients were included in the study, with a mean age of 76 years old. Among the recruited participants, 21 (6.5%) had a prevalent delirium according to the CAM, and 30 (10.2%) had an incident delirium. According to the 4AT, 48 patients (14.9%) had cognitive impairment and 81 (25.2%) had a prevalent delirium. According to the TICS, 87 patients (29.2%) have cognitive impairment. The 4AT has a sensitivity of 68,4% (IC 95% : 47,5-89,3) and a specificity of 73.2% (IC 95% : 67,8-78,7) for delirium, and a sensitivity of 50% (IC 95% : 35,9-64,1) and a specificity of 87,0% (IC 95% : 81,2-92) for cognitive impairment. Conclusion: The French Version of the 4AT could be a fast and reliable screening tool for delirium and cognitive impairment in ED. Further research is necessary for its validation in the ED.

The association between C-reactive protein and delirium in 710 acute elderly hospital admissions

2014 ◽  
Vol 26 (5) ◽  
pp. 717-724 ◽  
Author(s):  
C.W. Ritchie ◽  
T.H. Newman ◽  
B. Leurent ◽  
E.L. Sampson
Keyword(s):  
Cardiovascular Disease ◽  
Hospital Admissions ◽  
Inflammatory Marker ◽  
Strong Association ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Musculoskeletal Disease ◽  
C Reactive Protein ◽  
Musculoskeletal Infection ◽  
Reactive Protein

ABSTRACTBackground:Delirium is a common neuropsychiatric syndrome associated with poor outcomes. Evidence supports a neuroinflammatory etiology, but the role of the inflammatory marker C-reactive protein (C-RP) remains unclear. We investigated the relationship between C-RP and delirium and its severity as well as interaction with medical diagnosis.Methods:From an existing database (710 patients over 70 years old admitted to a Medical Acute Admissions Unit) we analyzed data which included C-RP levels, delirium (using the Confusion Assessment Method), and other clinical and demographic factors. Primary diagnoses were grouped (cardiovascular, musculoskeletal, infection, metabolic, and other).Results:There was a strong association between elevated C-RP and delirium (t = 5.09; p < 0.001), independent of other potential risk factors for delirium (odds ratio (OR) = 1.32 (95% CI: 1.10–1.58) p = 0.003). There was no significant association between C-RP and delirium severity, and between C-RP and delirium in the populations with cardiovascular disease, infection upon admission, or from the metabolic group despite an OR of 2.24 (95% CI: 0.92–5.45). There was an association in the musculoskeletal group (OR 2.19 (95% CI: 1.19–4.02)).Conclusions: There is an association between elevated C-RP and delirium. This is strongest in patients admitted with musculoskeletal disease but not in others, implying that C-RP is involved in the genesis of delirium in musculoskeletal disease, but that other factors or processes may be more important in those with cardiovascular disease or infection.

scholarly journals Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 903-910 ◽  
Author(s):  
Anne-Julie Gagné ◽  
Philippe Voyer ◽  
Valérie Boucher ◽  
Alexandra Nadeau ◽  
Pierre-Hugues Carmichael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Systematic Screening ◽  
French Version ◽  
Administration Time ◽  
Older Inpatients ◽  
Patients At Risk

CLINICIAN’S CAPSULEWhat is known about the topic?Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A’s Test (4AT), was created and validated for the detection of delirium.What did this study ask?This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium.What did this study find?The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED).Why does this study matter to clinicians?Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.

scholarly journals P047: Frailty assessment to help predict patients at risk of ED-induced delirium

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S94-S94
Author(s):  
M. Giroux ◽  
V. Boucher ◽  
M. Émond ◽  
M. Sirois ◽  
R. Daoust ◽  
...  
Keyword(s):  
At Risk ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Impact Measurement ◽  
Clinical Frailty Scale ◽  
Patients At Risk ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Introduction: Delirium is a frequent complication among seniors in the emergency department (ED). This condition is often underdiagnosed by ED professionals even though it is associated with functional & cognitive decline, longer hospital length of stay, institutionalization and death. Frailty is increasingly recognized as an independent predictor of adverse events in seniors and screening for frailty in EDs has recently been recommended. The aim of this study was to assess if screening seniors for frailty in EDs could help identify those at risk of ED-induced delirium. Methods: This study is part of the Incidence and Impact measurement of Delirium Induced by ED-Stay study, an ongoing multicenter prospective cohort study in 5 Quebec EDs. Patients were recruited after 8 hours in the ED exposure & followed up to 24h after ward admission. Frailty was assessed at ED admission using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) which classified seniors from robust (1/7) to severely frail (7/7). Seniors with CSHA-CFS ≥ 5/7 were considered frail. Delirium was assessed using the Confusion assessment method and Delirium Index. Results: Of the 380 patients recruited, mean age was 76.5 (±8.9). Male were 50%. Mean stay in the ED was 1.4 day (±0.82). Preliminary data show an incidence of ED-induced delirium of 8.4%. Average frailty score at baseline was 3.5/7. 72 patients were considered frail, while 289 were considered robust. Among the frail seniors, there were 48.4% (30-66%) patients with ED-induced delirium vs 17.9% (13.7-22.0] in the non-frail ones (p<0.0001). Conclusion: Increased frailty appears to be associated with increased ED-induced delirium. Screening for frailty at emergency triage could help ED professionals identify seniors at higher risk of ED-induced delirium. Further studies are required to confirm the importance of the association between frailty and ED-induced delirium

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