scholarly journals Delirium Assessment in Older People in Emergency Departments. A Literature Review

Diseases ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 14 ◽  
Author(s):  
Pilar Pérez-Ros ◽  
Francisco Martínez-Arnau
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Sensitivity And Specificity ◽  
Emergency Departments ◽  
Rating Scales ◽  
Healthcare Providers ◽  
High Sensitivity ◽  
Delirium Assessment ◽  
Systematic Screening ◽  
Emergency Department Staff

Delirium is a neuropsychiatric syndrome often manifesting in acute disease conditions, and with a greater prevalence in the older generation. Delirium in the Emergency Department (ED) is a highly prevalent problem that typically goes unnoticed by healthcare providers. The onset of a delirium episode in the ED is associated with an increase in morbidity and mortality. Because delirium is a preventable syndrome, these statistics are unacceptable. Emergency Department staff therefore should strive to perform systematic screening in order to detect delirium. Different tools have been developed for the assessment of delirium by healthcare professionals other than psychiatrists or geriatricians. Emergency Departments require delirium assessment scales of high sensitivity and specificity, suited to the characteristics of the Department, since the time available is scarce. In addition, the presence of dementia in the assessment of delirium may induce sensitivity bias. Despite the existence of numerous delirium rating scales, scales taking less than three minutes to complete are recommended. The choice of the tool depends on the characteristics of the ED. The only scale affording high sensitivity and specificity in older people with and without dementia is the Four “A”s Test (4AT); it requires no training on the part of the rater, and can be performed in under two minutes.

Delirium assessment in patients with advanced cancer presenting to the emergency department of a comprehensive cancer center.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 217-217
Author(s):  
Ahmed F. Elsayem ◽  
Alan D. Valentine ◽  
Carla L. Warneke ◽  
Valda D Page ◽  
Eduardo Bruera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Advanced Cancer ◽  
Emergency Departments ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Poor Survival ◽  
Delirium Assessment ◽  
English Speaking ◽  
Md Anderson

217 Background: The exact frequency of delirium among patients with advanced cancer presenting to emergency departments (EDs) is unknown. The purpose of this study is to determine the prevalence of delirium among patients with advanced cancer who present to the ED at MD Anderson Cancer Center. Methods: The exact frequency of delirium among patients with advanced cancer presenting to emergency departments (EDs) is unknown. The purpose of this study is to determine the prevalence of delirium among patients with advanced cancer who present to the ED at MD Anderson Cancer Center. Results: A total of 624 patients were screen for this study, and 243 patients were enrolled. The main reasons for exclusion were: 1) cancer was not advanced, 2) the patient had been in the ED for over 12 hours and 3) the patient was non-English speaking. The median age for all patients enrolled was 62 years (range 19 – 89 years), 167 (69%) were white, and 120(49.4) were female. CAM was positive in 22(9%) of patients. The median MDAS score of CAM positive patients was 14 (range 9 – 22 out of 30). Ten (10%)of 99 patients aged 65 and older were delirious as compared to 12 (8%) of 144 patients younger than 65 years (p = 0.6). Physician correctly predicted delirium in 13 patients (59%). Among the patients who were CAM positive 18 (82%) were admitted to the hospital as compared to 115 (52%) of patients without delirium (p = 0.012). Patients with delirium had higher hospital, and six months mortality rate. Conclusions: Delirium was identified in 9% of patients with advanced cancer visiting an ED, and is associated with more hospitalization and poor survival.

The dementia-friendly emergency department

2016 ◽  
Vol 30 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Belinda Parke ◽  
Kathleen F. Hunter
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Healthcare System ◽  
Emergency Departments ◽  
Hospital Setting ◽  
Multiple Challenges ◽  
Canadian Healthcare System ◽  
Canadian Healthcare ◽  
Health Profiles

Emergency Departments (EDs) are an integral part of the Canadian healthcare system. Older people living with dementia challenge EDs. They have complex health profiles that pose multiple challenges for staff. The current one-size-fits-all approach that aids efficiency in a technologically dependent hospital setting may not always serve older people living with dementia, their caregivers, or staff well. The premise that older people living with dementia are a problem for Canadian EDs must be reconsidered. Understanding the complexity of the situation is aided by the dementia-friendly ED framework. We propose one way to enhance communication between those living with dementia who receive ED services and those providing the service.

ENT cases seen at a local ‘walk-in centre’: a one year review

2008 ◽  
Vol 123 (3) ◽  
pp. 339-342 ◽  
Author(s):  
T Rourke ◽  
P Tassone ◽  
C Philpott ◽  
A Bath
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
General Practitioner ◽  
Emergency Departments ◽  
Foreign Bodies ◽  
Healthcare Providers ◽  
One Year

AbstractAim and method:This retrospective study reviewed the ENT-related cases seen, and the discharge or transfer outcomes, at both a local ‘walk-in centre’ and the respective emergency department, over one year in Norwich.Results:Of the 7657 ENT cases seen at the walk-in centre, the commonest conditions included tonsillitis or pharyngitis, otalgia, cough, and deafness. In comparison, 1586 patients were seen at the emergency department, and the commonest conditions were epistaxis and throat foreign bodies. Of the ENT cases seen at the walk-in centre, 85.4 per cent were treated and discharged. Of the 14.6 per cent referred to other healthcare providers, 11.1 per cent were to the general practitioner. In comparison, the emergency department discharged 41.2 per cent and referred 58.8 per cent to other healthcare providers.Conclusion:This study indicates that ENT cases may constitute a large proportion of patients seen in walk-in centres, and that the case types seen may differ from those presenting to emergency departments. It also indicates that walk-in centres may potentially be assessing, treating and discharging 85.4 per cent of ENT patients seen.

scholarly journals Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

2019 ◽  
Vol 49 (1) ◽  
pp. 130-134
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Primary Outcome ◽  
Screening Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multicenter Cohort Study ◽  
Delirium Assessment ◽  
Lengths Of Stay ◽  
History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

Explicit Diagnostic Criteria for Transient Ischemic Attacks Used in the Emergency Department Are Highly Sensitive and Specific

2020 ◽  
pp. 1-6
Author(s):  
Carl H. Göbel ◽  
Sarah C. Karstedt ◽  
Thomas F. Münte ◽  
Hartmut Göbel ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Criteria ◽  
Sensitivity And Specificity ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
High Sensitivity ◽  
University Hospital ◽  
Care Hospital ◽  
Transient Ischemic Attacks

<b><i>Background:</i></b> Making a correct diagnosis of a transient ischemic attack (TIA) is prone to errors because numerous TIA mimics exist and there is a shortage of evidence-based diagnostic criteria for TIAs. In this study, we applied for the first time the recently proposed explicit diagnostic criteria for transient ischemic attacks (EDCT) to a group of patients presenting to the emergency department of a large German tertiary care hospital with a suspected TIA. The aim was to determine the sensitivity and specificity of the EDCT in its clinical application. <b><i>Methods:</i></b> A total of 128 patients consecutively presenting to the emergency department of the University Hospital of Lübeck, Germany, under the suspicion of a TIA were prospectively interviewed about their clinical symptoms at the time of presentation. The diagnosis resulting from applying the EDCT was compared to the diagnosis made independently by the senior physicians performing the usual diagnostic work-up (“gold standard”), allowing calculation of sensitivity and specificity of the EDCT. <b><i>Results:</i></b> EDCT achieved a sensitivity of 96% and a specificity of 88%. When adding the additional criterion F (“the symptoms may not be better explained by another medical or mental disorder”), specificity significantly increased to 98%. <b><i>Conclusions:</i></b> The data show that the EDCT in its modified version as proposed by us are a highly useful tool for clinicians. They display a high sensitivity and specificity to accurately diagnose TIAs in patients referred to the emergency department with a suspected TIA.

scholarly journals Designing research studies in writer’s cramp dystonia: an analysis of automated writing measures

2021 ◽  
Author(s):  
Noreen Bukhari-Parlakturk ◽  
Michael Lutz ◽  
Alec McConnell ◽  
Hussein Al-Khalidi ◽  
Joyce En-Hua Wang ◽  
...  
Keyword(s):  
Clinical Research ◽  
Sample Size ◽  
Rare Disease ◽  
Sensitivity And Specificity ◽  
Healthy Subjects ◽  
Rating Scales ◽  
Research Study ◽  
High Sensitivity ◽  
Clinical Research Study ◽  
Research Studies

ABSTRACTBackgroundWriter’s cramp (WC) dystonia presents with abnormal postures during the task of writing and is an ideal dystonia subtype to study disease mechanisms for all forms of focal dystonia. Development of novel therapies is contingent on identifying sensitive and specific measures that can relate to the clinical syndrome and achieve a realistic sample size to power clinical research study for a rare disease. Although there have been prior studies employing automated measures of writing kinematics, it remains unclear which measures can distinguish WC subjects with high sensitivity and specificity and how these measures relate to clinician rating scales and patient-reported disability. The goal of this study was to: 1-identify automated writing measures that distinguish WC from healthy subjects, 2-measure sensitivity and specificity of these automated measures as well as their association with established dystonia rating scales, and 3-determine the sample size needed for each automated measure to power a clinical research study.Methods21 WC dystonia and 22 healthy subjects performed a sentence-copying assessment on a digital tablet in a kinematic software and hand recognition software. The sensitivity and specificity of automated measures was calculated using a logistic regression model. Measures were then correlated with examiner and patient rating scales. Power analysis was performed for 2 clinical research designs using these automated measures.ResultsOf the 23 automated writing measures analyzed, only 3 measures showed promise for use in a clinical research study. The automated measures of writing legibility, duration, and peak acceleration were able to distinguish WC from healthy controls with high sensitivity and specificity, correlated with examiner-rated dystonia sub-score measures and demonstrated relatively smaller sample sizes suitable for research studies in a rare disease population.DiscussionWe identified novel automated writing outcome measures for use in clinical research studies of WC subjects which capture key aspects of the clinical disease and can serve as important readout of dystonia disease mechanism as well as future disease interventions.

Saddened Not Amused

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 680-680
Author(s):  
SANDRA JO HAMMER
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Well Being ◽  
Emergency Department Staff ◽  
Department Staff

To the Editor.— I am writing to express my outrage at your publication of the paper by D.S. Nelson (Pediatrics 1992;89:1089-1090) which I read with interest as the title was intriguing. Although humor and good stress reducing mechanisms are vitally important to the healthy maintenance and well-being of staff in emergency departments, this paper described what is in effect a derision of patients and parents, first by the emergency department staff and then by the author's bold affectation of this as research and a "fertile source of medical humor."

scholarly journals Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e028257 ◽  
Author(s):  
Mohammadkarim Bahadori ◽  
Seyyed Meysam Mousavi ◽  
Ehsan Teymourzadeh ◽  
Ramin Ravangard
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Departments ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Military Hospital ◽  
Complex Nature ◽  
Negative Consequences ◽  
Middle Income ◽  
Emergency Medicine Resident

ObjectiveTo explore the causes and consequences of non-urgent visits to emergency departments in Iran and then suggest solutions from the healthcare providers’ viewpoint.DesignQualitative descriptive study with in-depth, open-ended, and semistructured interviews, which were inductively analysed using qualitative content analysis.SettingA territorial, educational and military hospital in Iran.ParticipantsEleven healthcare providers including eight nurses, two emergency medicine specialists and one emergency medicine resident.ResultsThree overarching themes of causes and consequences of non-urgent visits to the emergency department in addition to four suggested solutions were identified. The causes have encompassed the specialised services in emergency department, demand-side factors, and supply-side factors. The consequences have been categorised into three overarching themes including the negative consequences on patients, healthcare providers and emergency departments as well as the health system in general. The possible solutions for limiting and controlling non-urgent visits also involved regulatory plans, awareness-raising plans, reforms in payment mechanisms, and organisational arrangements.ConclusionWe highlighted the need for special attention to the appropriate use of emergency departments in Iran as a middle-income country. According to the complex nature of emergency departments and in order to control and prevent non-urgent visits, it can be suggested that policy-makers should design and implement a combination of the possible solutions.

scholarly journals Emergency department staff priorities for improving palliative care provision for older people: A qualitative study

2017 ◽  
Vol 32 (2) ◽  
pp. 417-425 ◽  
Author(s):  
Rebecca J Wright ◽  
Karen Lowton ◽  
Glenn Robert ◽  
Corita R Grudzen ◽  
Patricia Grocott
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Qualitative Study ◽  
Older People ◽  
Care Provision ◽  
Emergency Department Staff ◽  
Department Staff

An assessment of Chemical, Biological, Radiologic, Nuclear, and Explosive preparedness among emergency department healthcare providers in an inner city emergency department

2015 ◽  
Vol 13 (5) ◽  
pp. 431 ◽  
Author(s):  
Joseph G. Kotora, DO, MPH
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Survey Study ◽  
Care Providers ◽  
Adequate Knowledge ◽  
Practice Experience ◽  
Midlevel Providers

Introduction: Emergency healthcare providers are required to care for victims of Chemical, Biological, Radiologic, Nuclear, and Explosive (CBRNE) agents. However, US emergency departments are often ill prepared to manage CBRNE casualties. Most providers lack adequate knowledge or experience in the areas of patient decontamination, hospital-specific disaster protocols, interagency familiarization, and available supply of necessary medical equipment and medications. This study evaluated the CBRNE preparedness of physicians, nurses, and midlevel providers in an urban tertiary care emergency department.Methods: This retrospective observational survey study used a previously constructed questionnaire instrument. A total of 205 e-mail invitations were sent to 191 eligible providers through an online survey distribution tool (Survey Monkey®). Respondents were enrolled from February 1, 2014 to March 15, 2014. Simple frequencies of correct answers were used to determine the level of preparedness of each group. Cronbach’s coefficient á was used to validate the precision of the study instrument. Finally, validity coefficients and analysis of variance ANOVA were used to determine the strength of correlation between demographic variables, as well as the variation betweenindividual responses. Results: Fifty-nine providers responded to the questionnaire (31.14 percent response rate). The overall frequency of correct answers was 66.26 percent, indicating a relatively poor level of CBRNE preparedness. The study instrument lacked precision and reliability (coefficient á 0.4050). Significant correlations were found between the frequency of correct answers and the respondents’ gender, practice experience, and previous experience with a CBRNE incident. Significant variance exists between how providers believe casualties should be decontaminated, which drugs should be administered, and the interpretation of facility-specific protocols.Conclusions: Emergency care providers are inadequately prepared to manage CBRNE incidents. Furthermore, a valid and precise instrument capable of measuring preparedness needs to be developed. Standardized educational curriculums that consider healthcare providers’ genders, occupations, and experience levels may assist in closing the knowledge gaps between providers and reinforce emergency departments’ CBRNE preparedness.

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