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Morganti W, Custodero C, Veronese N, Topinkova E, Michalkova H, Polidori MC, Cruz-Jentoft AJ, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Seminerio E, Zieschang T, Padovani A, Sanchez-Garcia E, Pilotto A. The Multidimensional Prognostic Index predicts incident delirium among hospitalized older patients with COVID-19: a multicenter prospective European study. Eur Geriatr Med 2024; 15:961-969. [PMID: 38878221 PMCID: PMC11377617 DOI: 10.1007/s41999-024-00987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/01/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE Incident delirium is a frequent complication among hospitalized older people with COVID-19, associated with increased length of hospital stay, higher morbidity and mortality rates. Although delirium is preventable with early detection, systematic assessment methods and predictive models are not universally defined, thus delirium is often underrated. In this study, we tested the role of the Multidimensional Prognostic Index (MPI), a prognostic tool based on Comprehensive Geriatric Assessment, to predict the risk of incident delirium. METHODS Hospitalized older patients (≥ 65 years) with COVID-19 infection were enrolled (n = 502) from ten centers across Europe. At hospital admission, the MPI was administered to all the patients and two already validated delirium prediction models were computed (AWOL delirium risk-stratification score and Martinez model). Delirium occurrence during hospitalization was ascertained using the 4A's Test (4AT). Accuracy of the MPI and the other delirium predictive models was assessed through logistic regression models and the area under the curve (AUC). RESULTS We analyzed 293 patients without delirium at hospital admission. Of them 33 (11.3%) developed delirium during hospitalization. Higher MPI score at admission (higher multidimensional frailty) was associated with higher risk of incident delirium also adjusting for the other delirium predictive models and COVID-19 severity (OR = 12.72, 95% CI = 2.11-76.86 for MPI-2 vs MPI-1, and OR = 33.44, 95% CI = 4.55-146.61 for MPI-3 vs MPI-1). The MPI showed good accuracy in predicting incident delirium (AUC = 0.71) also superior to AWOL tool, (AUC = 0.63) and Martinez model (AUC = 0.61) (p < 0.0001 for both comparisons). CONCLUSIONS The MPI is a sensitive tool for early identification of older patients with incident delirium.
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Affiliation(s)
- Wanda Morganti
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - M Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, Ageing Clinical Research, University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging- Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | | | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central/Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Emanuele Seminerio
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Tania Zieschang
- University-Clinic for Geriatric Medicine, Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Alberto Pilotto
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
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Carpenter CR, Lee S, Kennedy M, Arendts G, Schnitker L, Eagles D, Mooijaart S, Fowler S, Doering M, LaMantia MA, Han JH, Liu SW. Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments. Acad Emerg Med 2024. [PMID: 38757369 DOI: 10.1111/acem.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test-treatment thresholds for ED delirium screening. METHODS We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta-analysis and estimated delirium screening thresholds. RESULTS Full-text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta-analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7-20.7) and rule out (pooled negative likelihood ratio [LR-] 0.18, 95% CI 0.09-0.34) delirium. We also conducted meta-analysis of two studies that quantified the accuracy of the Abbreviated Mental Test-4 (AMT-4) and found that the pooled LR+ (4.3, 95% CI 2.4-7.8) was lower than that observed for the 4AT, but the pooled LR- (0.22, 95% CI 0.05-1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%. CONCLUSIONS The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED-based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM-ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single-center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single-center study.
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Affiliation(s)
| | - Sangil Lee
- University of Iowa, Iowa City, Iowa, USA
| | - Maura Kennedy
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Glenn Arendts
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Linda Schnitker
- Bolton Clarke Research Institute, Bolton Clarke School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Simon Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Susan Fowler
- University of Connecticut Health Sciences, Farmington, Connecticut, USA
| | - Michelle Doering
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Jin H Han
- Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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3
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Morales-Puerto M, Ruiz-Díaz M, García-Mayor S, León-Campos Á, Morales-Asencio JM, Canca-Sánchez JC, Gavira-Guerra S, Toledo-Fernandez C, Aranda-Gallardo M. Spanish transcultural adaptation of the 4AT score for the evaluation of delirium in the emergency department: a prospective diagnostic test accuracy study. BMC Nurs 2024; 23:101. [PMID: 38321514 PMCID: PMC10845719 DOI: 10.1186/s12912-023-01638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/05/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Delirium is one of the most common adverse events in older people during hospitalization, especially in the emergency department. Reliable, easy-to-use instruments are necessary to properly manage delirium in this setting. This study aims to evaluate the diagnostic validity of the Spanish version of the 4 'A's Test (4AT) in the ED. METHODS A diagnostic accuracy study was conducted in patients over 65 years old admitted to the Emergency Department who did not have a formal diagnosis of dementia or a severe mental health disorder. Face and content validity were evaluated by an expert panel. Emergency nurses performed the evaluation with 4AT, whilst blinded and trained researchers assessed patients with the Revised Delirium Rating Scale as the gold standard. The content validity index, sensitivity, specificity, positive and negative predictive values, likelihood ratios, Youden's Index and ROC curves were calculated to evaluate the diagnostic accuracy of the instrument. RESULTS Of 393 eligible patients, 380 were finally analyzed. Content validity yielded a median content validity index of 4 (interquartile range: 0). The Spanish 4AT sensitivity (95.83%; 95% ECI: 78.9-99.9%), specificity (92.98%; 95% CI: 89.8-95.4%), positive predictive value (47.92%) and negative predictive value (99.7%) were satisfactory. Youden's index was 0.89. Positive likelihood ratio was 13.65, and negative likelihood ratio 0.045. The area under the curve was 0.97. CONCLUSIONS The Spanish version of the 4AT for use in the Emergency Departments is easy-to-use and applicable. The validation results indicate that it is a valid instrument with sufficient predictive validity to identify patients at risk of delirium in the Emergency Departments. Moreover, it is a tool that facilitates the management of an adverse event that is associated with increased mortality and morbidity.
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Affiliation(s)
- Marta Morales-Puerto
- Hospital Costa del Sol. Servicio Andaluz de Salud, Autovía A7, Km. 187. Marbella, Malaga, 29603, Spain
| | - María Ruiz-Díaz
- Hospital Costa del Sol. Servicio Andaluz de Salud, Autovía A7, Km. 187. Marbella, Malaga, 29603, Spain
| | - Silvia García-Mayor
- Faculty of Health Sciences, Department of Nursing, Universidad de Málaga, C/ Arquitecto Francisco Peñalosa 3, Malaga, 29017, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), C/ Miguel Díaz Recio, Malaga, 29010, Spain
| | - Álvaro León-Campos
- Faculty of Health Sciences, Department of Nursing, Universidad de Málaga, C/ Arquitecto Francisco Peñalosa 3, Malaga, 29017, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), C/ Miguel Díaz Recio, Malaga, 29010, Spain.
| | - José Miguel Morales-Asencio
- Faculty of Health Sciences, Department of Nursing, Universidad de Málaga, C/ Arquitecto Francisco Peñalosa 3, Malaga, 29017, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), C/ Miguel Díaz Recio, Malaga, 29010, Spain
| | - José Carlos Canca-Sánchez
- Hospital Costa del Sol. Servicio Andaluz de Salud, Autovía A7, Km. 187. Marbella, Malaga, 29603, Spain
- Faculty of Health Sciences, Department of Nursing, Universidad de Málaga, C/ Arquitecto Francisco Peñalosa 3, Malaga, 29017, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), C/ Miguel Díaz Recio, Malaga, 29010, Spain
| | - Sonia Gavira-Guerra
- Hospital Costa del Sol. Servicio Andaluz de Salud, Autovía A7, Km. 187. Marbella, Malaga, 29603, Spain
| | - Cecilia Toledo-Fernandez
- Hospital Costa del Sol. Servicio Andaluz de Salud, Autovía A7, Km. 187. Marbella, Malaga, 29603, Spain
| | - Marta Aranda-Gallardo
- Hospital Costa del Sol. Servicio Andaluz de Salud, Autovía A7, Km. 187. Marbella, Malaga, 29603, Spain
- Faculty of Health Sciences, Department of Nursing, Universidad de Málaga, C/ Arquitecto Francisco Peñalosa 3, Malaga, 29017, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), C/ Miguel Díaz Recio, Malaga, 29010, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Bizkaia, Spain
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4
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Pouw MA, Calf AH, Georg RR, de Rooij SE, Ter Maaten JC, van Munster BC. Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting. Aging Clin Exp Res 2023:10.1007/s40520-023-02447-2. [PMID: 37285074 PMCID: PMC10363057 DOI: 10.1007/s40520-023-02447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Delirium is an acute disturbance in attention, awareness and cognition. Immediate detection in older adults is recommended because delirium is associated with adverse outcomes. The 4 'A's Test (4AT) is a short screening instrument for delirium. The aim of this study is to evaluate diagnostic accuracy of the Dutch version of the screening tool 4AT for delirium detection in different settings. METHODS Prospective observational study conducted in two hospitals in patients aged ≥ 65 years in geriatric wards and the Emergency Department (ED). Each participant underwent two assessments; the index test 4AT, followed by the reference standard for delirium performed by a geriatric care specialist. The reference standard delirium is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. RESULTS A total of 71 geriatric inpatients and 49 older ED patients were included. The prevalence of delirium was 11.6% in the acute geriatric ward and 6.1% in the ED. The sensitivity and specificity of the 4AT in the acute geriatric ward were 0.88 and 0.69, respectively. In the ED, the sensitivity and specificity were 0.67 and 0.83, respectively. The area under the receiver operating characteristic curve was 0.80 for the acute geriatric ward setting and 0.74 for the ED setting. CONCLUSION The Dutch version of the 4AT is a reliable screening tool for delirium detection in both acute geriatric wards and ED. Due to its brevity and practicality (i.e., no special training is required to administer the tool), it is useful in clinical practice.
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Affiliation(s)
- Maaike A Pouw
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Agneta H Calf
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Rita R Georg
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Sophia E de Rooij
- Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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Mate K, Fulmer T, Pelton L, Berman A, Bonner A, Huang W, Zhang J. Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum. J Aging Health 2021; 33:469-481. [PMID: 33555233 PMCID: PMC8236661 DOI: 10.1177/0898264321991658] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.
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Affiliation(s)
- Kedar Mate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Amy Berman
- The John A. Hartford Foundation, New York, NY, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Wendy Huang
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinghan Zhang
- Columbia University Mailman School of Public Health, New York, NY, USA
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6
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Hu KM, Brown RM. Resuscitation of the Critically Ill Older Adult. Emerg Med Clin North Am 2021; 39:273-286. [PMID: 33863459 DOI: 10.1016/j.emc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 30 years, adults 65 and older will represent 20% of the US population, with increased medical comorbidities leading to higher rates of critical illness and mortality. Despite significant acute illness, presenting symptoms and vital sign abnormalities may be subtle. Resuscitative guidelines are a helpful starting point but appropriate diagnostics, bedside ultrasound, and frequent reassessments are needed to avoid procrustean care that may worsen outcomes. Baseline functional status is as important as underlying comorbid conditions when prognosticating, and the patient's personal wishes should be sought early and throughout care with clear communication regarding prospects for immediate survival and overall recovery.
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Affiliation(s)
- Kami M Hu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Internal Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Robert M Brown
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Carilion Roanoke Memorial Hospital, 1906 Belleview Ave SE, Roanoke, VA 24014, USA
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Calf AH, Pouw MA, van Munster BC, Burgerhof JGM, de Rooij SE, Smidt N. Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis. Age Ageing 2021; 50:105-112. [PMID: 33009909 PMCID: PMC7793600 DOI: 10.1093/ageing/afaa183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Indexed: 11/16/2022] Open
Abstract
Background cognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes. Methods we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed. Results 23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71–0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A’s Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74–0.94). Conclusions high clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED. The review protocol was registered in PROSPERO (CRD42018082509).
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Affiliation(s)
- Agneta H Calf
- Department of Geriatrics, University Medical Center Groningen, Groningen, The Netherlands
| | - Maaike A Pouw
- Department of Geriatrics, University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Geriatrics, University Medical Center Groningen, Groningen, The Netherlands
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophia E de Rooij
- Department of Geriatrics, University Medical Center Groningen, Groningen, The Netherlands
- Medical Spectrum Twente, Medical School Twente, Enschede, The Netherlands
| | - Nynke Smidt
- Department of Geriatrics, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Carpenter CR, Hammouda N, Linton EA, Doering M, Ohuabunwa UK, Ko KJ, Hung WW, Shah MN, Lindquist LA, Biese K, Wei D, Hoy L, Nerbonne L, Hwang U, Dresden SM. Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement. Acad Emerg Med 2021; 28:19-35. [PMID: 33135274 DOI: 10.1111/acem.14166] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Older adult delirium is often unrecognized in the emergency department (ED), yet the most compelling research questions to overcome knowledge-to-practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized to identify and prioritize delirium clinical questions. METHODS GEAR identified and engaged 49 transdisciplinary stakeholders including emergency physicians, geriatricians, nurses, social workers, pharmacists, and patient advocates. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews, clinical questions were derived, medical librarian electronic searches were conducted, and applicable research evidence was synthesized for ED delirium detection, prevention, and management. The scoping review served as the foundation for a consensus conference to identify the highest priority research foci. RESULTS In the scoping review, 27 delirium detection "instruments" were described in 48 ED studies and used variable criterion standards with the result of delirium prevalence ranging from 6% to 38%. Clinician gestalt was the most common "instrument" evaluated with sensitivity ranging from 0% to 81% and specificity from 65% to 100%. For delirium management, 15 relevant studies were identified, including one randomized controlled trial. Some intervention studies targeted clinicians via education and others used clinical pathways. Three medications were evaluated to reduce or prevent ED delirium. No intervention consistently prevented or treated delirium. After reviewing the scoping review results, the GEAR stakeholders identified ED delirium prevention interventions not reliant on additional nurse or physician effort as the highest priority research. CONCLUSIONS Transdisciplinary stakeholders prioritize ED delirium prevention studies that are not reliant on health care worker tasks instead of alternative research directions such as defining etiologic delirium phenotypes to target prevention or intervention strategies.
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Affiliation(s)
- Christopher R. Carpenter
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MIUSA
| | - Nada Hammouda
- the Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Elizabeth A. Linton
- the Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York NYUSA
- the Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MDUSA
| | - Michelle Doering
- the Becker Medical Library Washington University in St. Louis School of Medicine St. Louis MOUSA
| | - Ugochi K. Ohuabunwa
- the Division of General Medicine and Geriatrics Emory University School of Medicine Atlanta GAUSA
| | - Kelly J. Ko
- Clinical Research West Health Institute La Jolla CAUSA
| | - William W. Hung
- James J. Peters VA Medical Center Bronx NYUSA
- and the Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Manish N. Shah
- the BerbeeWalsh Department of Emergency Medicine University of Wisconsin–Madison Madison WIUSA
| | - Lee A. Lindquist
- the Department of Medicine Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - Kevin Biese
- the Departments of Emergency Medicine and Internal Medicine University of North Carolina at Chapel Hill Chapel Hill NCUSA
| | - Daniel Wei
- the BerbeeWalsh Department of Emergency Medicine University of Wisconsin–Madison Madison WIUSA
| | | | | | - Ula Hwang
- the Department of Emergency Medicine Yale School of Medicine New Haven CTUSA
| | - Scott M. Dresden
- and the Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
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CAM-ICU may not be the optimal screening tool for early delirium screening in older emergency department patients: a prospective cohort study. Eur J Emerg Med 2020; 26:428-432. [PMID: 30585854 DOI: 10.1097/mej.0000000000000587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Delirium is a frequent problem among older patients in the emergency department (ED) and early detection is important to prevent its associated adverse outcomes. Several screening tools for delirium have been proposed for the ED, such as the 6-Item Cognitive Impairment Test (6-CIT) and the Confusion Assessment Method-ICU (CAM-ICU). Previous validation of the CAM-ICU for use in the ED showed varying results, possibly because it was administered at different or unknown time points. The aim was to study the prevalence of delirium in older ( ≥ 70 years) ED patients using the CAM-ICU and 6-CIT. PARTICIPANTS AND METHODS A prospective cohort study was carried out in one tertiary care and one secondary care hospital in the Netherlands. Patients aged 70 years and older attending the ED were included. Delirium screening was performed within 1 h after ED registration using the CAM-ICU. The 6-CIT was determined for comparison using a cut-off point of at least 14 points indicating possible delirium. RESULTS A total of 997 patients were included in the study, with a median age of 78 years (interquartile range 74-84). Delirium as assessed with CAM-ICU was positive in only 13 (1.3%, 95% confidence interval: 0.8-2.2) patients. Ninety-five (9.5% 95% confidence interval: 7.9-11.5) patients had 6-CIT more than or equal to 14. CONCLUSION We found a delirium prevalence of 1.3% using the CAM-ICU, which was much lower than the expected prevalence of around 10% as being frequently reported in the literature and what we found when using the 6-CIT. On the basis of these results, caution is warranted to use the CAM-ICU for early screening in the ED.
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10
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Preventive effect of dexmedetomidine on postictal delirium after electroconvulsive therapy. Eur J Anaesthesiol 2020; 37:5-13. [DOI: 10.1097/eja.0000000000001113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boucher V, Lamontagne ME, Nadeau A, Carmichael PH, Yadav K, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Morin M, Lemire S, Minh Vu TT, Lee J, Émond M. Unrecognized Incident Delirium in Older Emergency Department Patients. J Emerg Med 2019; 57:535-542. [DOI: 10.1016/j.jemermed.2019.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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12
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Wongviriyawong T, Sura‐arunsumrit P, Chaiwat O, To‐Adithep P, Ramlee R, Srinonprasert V. Diagnosis of postoperative delirium in older adults using the Confusion Assessment Method for the intensive care unit in non‐intensive care unit settings: A test modification might improve its diagnostic performance. Geriatr Gerontol Int 2019; 19:762-767. [DOI: 10.1111/ggi.13695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/23/2019] [Accepted: 05/05/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Titima Wongviriyawong
- Department of Medicine, Faculty of MedicineSiriraj Hospital, Mahidol University Bangkok Thailand
| | | | - Onuma Chaiwat
- Department of Anesthesiology, Faculty of MedicineSiriraj Hospital, Mahidol University Bangkok Thailand
| | - Puriwat To‐Adithep
- Department of Anesthesiology, Faculty of MedicineSiriraj Hospital, Mahidol University Bangkok Thailand
| | - Rachaneekorn Ramlee
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of MedicineSiriraj Hospital, Mahidol University Bangkok Thailand
| | - Varalak Srinonprasert
- Department of Medicine, Faculty of MedicineSiriraj Hospital, Mahidol University Bangkok Thailand
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13
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Pérez-Ros P, Martínez-Arnau FM. Delirium Assessment in Older People in Emergency Departments. A Literature Review. Diseases 2019; 7:E14. [PMID: 30704024 PMCID: PMC6473718 DOI: 10.3390/diseases7010014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Pilar Pérez-Ros
- School of Nursing, Universidad Católica de Valencia San Vicente Mártir, Calle Espartero, 7, 46007 València, Spain.
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14
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Hasemann W, Grossmann FF, Stadler R, Bingisser R, Breil D, Hafner M, Kressig RW, Nickel CH. Screening and detection of delirium in older ED patients: performance of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A two-step tool. Intern Emerg Med 2018; 13:915-922. [PMID: 29290048 DOI: 10.1007/s11739-017-1781-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/20/2017] [Indexed: 12/22/2022]
Abstract
Delirium is frequent in older Emergency Department (ED) patients, but detection rates for delirium in the ED are low. To aid in identifying delirium, we developed and implemented a two-step systematic delirium screening and assessment tool in our ED: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Components of the mCAM-ED include: (1) screening for inattention, the main feature of delirium, which was performed with the Months Backwards Test (MBT); (2) delirium assessment based on a structured interview with questions from the Mental Status Questionnaire by Kahn et al. and the Comprehension Test by Hart et al. The aims of our study are (1) to investigate the performance criteria of the mCAM-ED tool in a consecutive sample of older ED patients, (2) to evaluate the performance of the mCAM-ED in patients with and without dementia and (3) to test whether this tool is efficient in keeping evaluation time to a minimum and reducing screening and assessment burden on the patient. For this prospective validation study, we recruited a consecutive sample of ED patients aged 65 and older during an 11-day period in November 2015. Trained nurses assessed patients with the mCAM-ED. Results were compared to the reference standard [i.e. the geriatricians' delirium diagnosis based on the criteria of the Text Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)]. Performance criteria were computed. We included 286 consecutive ED patients aged 65 and older. The median age was 80.02 (Q1 = 72.15; Q3 = 86.76), 58.7% of included patients were female, 14.3% had dementia. We found a delirium prevalence of 7.0%. In patients with dementia, specificity and positive likelihood ratio were lower. When compared to the reference standard, delirium assessment with the mCAM-ED has a 0.98 specificity and a 39.9 positive likelihood ratio. In 80.0% of all cases, the first step of the mCAM-ED, i.e. screening for inattention with the MBT, took less than 30 s. On average, the complete mCAM-ED assessment required 3.2 (SD 2.0), 5.6 (SD 3.2), and 6.2 (SD 2.3) minutes in cognitively unimpaired patients, patients with dementia and patients with dementia or delirium, respectively. The mCAM-ED is able to efficiently rule out delirium as well as confirm the diagnosis of delirium in elderly patients with and without dementia and applies minimal screening and assessment burden on the patient.
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Affiliation(s)
- Wolfgang Hasemann
- Department of Nursing and Allied Health Professions, University Hospital Basel, Hebelstrasse 2, Basel, 4031, Switzerland.
| | | | - Rahel Stadler
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Dieter Breil
- University Center for Medicine of Aging, Felix Platter Hospital Basel, Basel, Switzerland
| | - Martina Hafner
- University Center for Medicine of Aging, Felix Platter Hospital Basel, Basel, Switzerland
| | - Reto W Kressig
- University Center for Medicine of Aging, Felix Platter Hospital Basel, Basel, Switzerland
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15
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Lucke JA, de Gelder J, Heringhaus C, van der Mast RC, Fogteloo AJ, Anten S, Blauw GJ, de Groot B, Mooijaart SP. Impaired cognition is associated with adverse outcome in older patients in the Emergency Department; the Acutely Presenting Older Patients (APOP) study. Age Ageing 2018; 47:679-684. [PMID: 29177470 DOI: 10.1093/ageing/afx174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/26/2017] [Indexed: 11/14/2022] Open
Abstract
Objective to investigate whether cognitive impairment, measured early after Emergency Department (ED) arrival and irrespective of its cause, is independently associated with functional decline or mortality after 3 and 12 months in older ED patients. Design and setting a prospective multi-centre cohort study in all Acutely Presenting Older Patients visiting the Emergency Department (APOP study) of three hospitals in the Netherlands. Participants 2,130 patients, ≥70 years. Measurements data on demographics, disease severity and geriatric characteristics were collected during the first hour of the ED visit. Cognition was measured using the 6-Item-Cognitive-Impairment-Test ('6CIT'). Cognitive impairment was defined as 6CIT ≥11, self-reported dementia or the inability to perform the cognition test. The composite adverse outcome after 3 and 12 months was defined as a 1-point decrease in Katz Activities of Daily Living (ADL), new institutionalisation or mortality. Multivariable regression analysis was used to assess whether cognitive impairment independently associates with adverse outcome. Results of 2,130 included patients, 588 (27.6%) had cognitive impairment at baseline and 654 patients (30.7%) suffered from adverse outcome after 3 months. Cognitive impairment associated with increased risk for adverse outcome (adjusted odds ratio (OR) 1.72, 95%CI 1.37-2.17). After 12 months, 787 patients (36.9%) suffered from adverse outcome. Again, cognitive impairment independently associated with increased risk for adverse outcome (adjusted OR 1.89, 95%CI 1.46-2.46). ORs were similar for patients who were discharged home versus hospitalised patients. Conclusion cognitive impairment measured during the early stages of ED visit, irrespective of the cause, is independently associated with adverse outcome after 3 and 12 months in older patients.
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Affiliation(s)
- J A Lucke
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J de Gelder
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - C Heringhaus
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - R C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - A J Fogteloo
- Department of Internal Medicine, section of Acute Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S Anten
- Department of Internal Medicine, section acute care, Alrijne Hospital, the Netherlands
| | - G J Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - B de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands
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Souza RCDS, Bersaneti MDR, Siqueira EMP, Meira L, Brumatti DL, Prado NRDO. Nurses' training in the use of a delirium screening tool. ACTA ACUST UNITED AC 2017; 38:e64484. [PMID: 28443974 DOI: 10.1590/1983-1447.2017.01.64484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/06/2017] [Indexed: 11/22/2022]
Abstract
Objective To narrate the nurses' training experience in the implementation of a systematic delirium screening tool using the Confusion Assessment Method for Intensive Care Unit. Method Experience report covering the steps of situation diagnosis, planning, staff training and evaluation of the tool's implementation between January and March 2013 with nurses in the ICU of a tertiary hospital in São Paulo. Results The implementation of the assessment, using the Confusion Assessment Method for Intensive Care Unit, obtained significant nurse adhesion and became a service indicator. Final considerations The experience has shown that this assessment allows the results of the work process to be analyzed and the consequent transformation of daily initiatives.
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Affiliation(s)
- Regina Cláudia da Silva Souza
- Hospital Sírio Libanês, Unidade de Terapia Intensiva, Serviço de Desenvolvimento de Enfermagem. São Paulo, São Paulo, Brasil
| | | | - Ellen Maria Pires Siqueira
- Hospital Sírio Libanês, Unidade de Terapia Intensiva, Serviço de Desenvolvimento de Enfermagem. São Paulo, São Paulo, Brasil
| | - Luciana Meira
- Hospital Sírio Libanês, Unidade de Terapia Intensiva, Serviço de Desenvolvimento de Enfermagem. São Paulo, São Paulo, Brasil
| | - Daiana Lepre Brumatti
- Hospital Sírio Libanês, Unidade de Terapia Intensiva, Serviço de Desenvolvimento de Enfermagem. São Paulo, São Paulo, Brasil
| | - Nilda Rosa de Oliveira Prado
- Hospital Sírio Libanês, Unidade de Terapia Intensiva, Serviço de Desenvolvimento de Enfermagem. São Paulo, São Paulo, Brasil
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Émond M, Grenier D, Morin J, Eagles D, Boucher V, Le Sage N, Mercier É, Voyer P, Lee JS. Emergency Department Stay Associated Delirium in Older Patients. Can Geriatr J 2017; 20:10-14. [PMID: 28396704 PMCID: PMC5383401 DOI: 10.5770/cgj.20.246] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium. METHODS A historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay. Delirium was detected using a modified chart-based Confusion Assessment Method (CAM) tool. Hospital length of stay (LOS) was log-transformed and linear regression assessed differences between groups. Adjustments were made for age and comorbidity profile. RESULTS 200 records were reviewed, 55.5% were female, median age was 78.9 yrs (SD:7.3). 36(18%) patients experienced ED-stay associated delirium. Nearly 50% of episodes started in the ED and within 36 hours of arrival. Comorbidity profile was similar between the positive CAM group and the negative CAM group. Mean adjusted hospital LOS were 20.5 days and 11.9 days respectively (p<.03). CONCLUSIONS 1 older adult out of 5 became delirious after a 12 hr ED stay. Since delirium increases hospital LOS by more than a week, better screening and implementation of preventing measures for delirium could reduce LOS and overcrowding in the ED.
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Affiliation(s)
- Marcel Émond
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - David Grenier
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Jacques Morin
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Debra Eagles
- Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Valérie Boucher
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada
| | - Natalie Le Sage
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Éric Mercier
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Philippe Voyer
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada; CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, QC, Canada
| | - Jacques S Lee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Lin H, Roberts RJ. Pharmacologic Consideration in the Elderly Trauma Patient. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0072-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Underreporting of Delirium in Statewide Claims Data: Implications for Clinical Care and Predictive Modeling. PSYCHOSOMATICS 2016; 57:480-8. [DOI: 10.1016/j.psym.2016.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 01/27/2023]
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Martín-Sánchez FJ, Christ M, Miró Ò, Peacock WF, McMurray JJ, Bueno H, Maisel AS, Cullen L, Cowie MR, Di Somma S, Platz E, Masip J, Zeymer U, Vrints C, Price S, Mueller C. Practical approach on frail older patients attended for acute heart failure. Int J Cardiol 2016; 222:62-71. [PMID: 27458825 DOI: 10.1016/j.ijcard.2016.07.151] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
Acute heart failure (AHF) is a multi-organ dysfunction syndrome. In addition to known cardiac dysfunction, non-cardiac comorbidity, frailty and disability are independent risk factors of mortality, morbidity, cognitive and functional decline, and risk of institutionalization. Frailty, a treatable and potential reversible syndrome very common in older patients with AHF, increases the risk of disability and other adverse health outcomes. This position paper highlights the need to identify frailty in order to improve prognosis, the risk-benefits of invasive diagnostic and therapeutic procedures, and the definition of older-person-centered and integrated care plans.
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Affiliation(s)
- Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Michael Christ
- Department of Emergency and Critical Care Medicine, Klinikum Nürnberg, Germany
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain; Institut de Recerca Biomàdica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - W Frank Peacock
- Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - John J McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, United States
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Martin R Cowie
- Cardiology Department, Imperial College London (Royal Brompton Hospital), London, England, United Kingdom
| | - Salvatore Di Somma
- Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Josep Masip
- ICU Department, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain; Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
| | - Uwe Zeymer
- Klinikum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Christiaan Vrints
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Susanna Price
- Royal Brompton and Harefield National Health Service Foundation Trust, United Kingdom
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
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