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Eeles E, Tran DD, Boyd J, Tronstad O, Teodorczuk A, Flaws D, Fraser JF, Dissanayaka N. A narrative review of the development and performance characteristics of electronic delirium-screening tools. Aust Crit Care 2024; 37:651-658. [PMID: 38102026 DOI: 10.1016/j.aucc.2023.11.006] [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: 06/25/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Electronic delirium-screening tools are an emergent area of research. OBJECTIVE The objective of this study was to summarise the development and performance characteristics of electronic screening tools in delirium. METHODS Searches were conducted in Pubmed, Embase, and CINAHL Complete databases to identify electronic delirium-screening tools. RESULTS Five electronic delirium-screening tools were identified and reviewed. Two were designed for and tested within a medical setting, and three were applied to intensive care. Adaptive design features, such as skip function to reduce test burden, were variably integrated into instrument design. All tools were shown to have acceptable psychometric properties, but validation studies were largely incomplete. CONCLUSIONS Electronic delirium-screening tools are an exciting area of development and may offer hope for improved uptake of delirium screening.
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Affiliation(s)
- Eamonn Eeles
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia; Northside Clinical School, School of Medicine, University of Queensland, Australia; Critical Care Research Group, School of Clinical Sciences, Queensland University of Technology, Department of Mental Health, Caboolture Hospital, University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia.
| | - David Duc Tran
- Critical Care Research Group, School of Clinical Sciences, Queensland University of Technology, Department of Mental Health, Caboolture Hospital, University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Jemima Boyd
- Allied Health Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Oystein Tronstad
- Critical Care Research Group Level 3, Clinical Sciences, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrew Teodorczuk
- Critical Care Research Group, School of Clinical Sciences, Queensland University of Technology, Department of Mental Health, Caboolture Hospital, University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Dylan Flaws
- Critical Care Research Group, School of Clinical Sciences, Queensland University of Technology, Department of Mental Health, Caboolture Hospital, University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group Level 3, Clinical Sciences, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Nadeeka Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
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2
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MacLullich AMJ, Hosie A, Tieges Z, Davis DHJ. Three key areas in progressing delirium practice and knowledge: recognition and relief of distress, new directions in delirium epidemiology and developing better research assessments. Age Ageing 2022; 51:afac271. [PMID: 36441120 PMCID: PMC9704028 DOI: 10.1093/ageing/afac271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
Delirium presents formidable challenges: it affects one in four of older hospitalised adults, greatly elevates the risk of multiple short- and long-term complications including dementia and causes significant distress. Delirium care remains generally poor. Yet, there are clear grounds for optimism; the last decade has seen impactful policy advances and a tripling of research output. Here, we highlight three linked areas which have strong potential to transform delirium practice and knowledge in the near term. Delirium-related distress is strikingly underrepresented in practice guidance and research. Proactive recognition combined with effective clinical responses based on good communication provides a critical and largely untapped opportunity to improve care. Delirium epidemiology research is well positioned to produce novel insights through advanced prospective designs in populations such as emergency medical patients with detailed pre-, intra- and post-delirium assessments allied with fluid, imaging and other biomarkers. Research-grade assessment of delirium currently involves a chaotic array of tools, methods and diagnostic algorithms. Areas for development: expand and analytically distinguish the range of features assessed (including distress), optimise feature assessment including use of validated neuropsychological tests where possible, produce standardised algorithms which articulate explicit pathways from features to diagnosis, and create new fine-grained approaches to the measurement of severity. Delirium practice and knowledge show accelerating growth. This is encouraging but much of the necessary progress is still to come. Innovation in these three highlighted areas, as well as many others, will open up exciting possibilities in enhancing the care of patients with this common and often devastating condition.
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Affiliation(s)
- Alasdair M J MacLullich
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annmarie Hosie
- School of Nursing and Midwifery, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
- The Cunningham Centre for Palliative Care, St Vincent’s Health Network Sydney, Darlinghurst, NSW, Australia
- IMPACCT – Improving Palliative, Aged and Chronic Care through Research and Translation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Zoë Tieges
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- SMART Technology Centre, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Daniel H J Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Tan TH, Yang TY, Chen YM, Chung SY, Liu HH, Yang PC, Kao PH, Peng AC, Shu YM, Chu YS, Tsai KT, Hsu CC, Ho CH, Lin HJ, Huang CC. Computerized tool and interdisciplinary care for older patients with delirium in the emergency department: a novel model in Taiwan. Aging Clin Exp Res 2022; 34:3137-3144. [PMID: 36071315 DOI: 10.1007/s40520-022-02240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
AIMS A computerized tool and interdisciplinary care were implemented to develop a novel model for older patients with delirium in the emergency department (ED). METHODS We developed a computerized tool using a delirium triage screen and brief confusion assessment in the hospital information system, performed education for the healthcare providers, and developed a continuous care protocol. Comparisons for outcomes between pre- and post-intervention periods were performed. RESULTS Compared with the pre-intervention period, patients in the post-intervention period had shorter hospitalization stay, lower expenditure of hospitalization, more likely to return home, lower ED revisits of ≤ 3 days, re-hospitalization of ≤ 14 days, and mortality of ≤ 1 month. All mentioned differences were not statistically significant. CONCLUSIONS A novel model was successfully developed for delirium management in older patients in the ED. Outcome differences were not significant; however, the result is promising, which gives us an important reference in the future.
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Affiliation(s)
- Tian-Hoe Tan
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ting-Ya Yang
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Yao-Mei Chen
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Shiu-Yuan Chung
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsiao-Hua Liu
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Pei-Chi Yang
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Pei-Hsin Kao
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - An-Chi Peng
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Min Shu
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Sheng Chu
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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4
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Hasemann W, Duncan N, Clarke C, Nouzova E, Süßenbach LM, Keerie C, Assi V, Weir CJ, Evans J, Walsh T, Wilson E, Quasim T, Middleton D, Weir AJ, Barnett JH, Stott DJ, MacLullich AMJ, Tieges Z. Comparing performance on the Months of the Year Backwards test in hospitalised patients with delirium, dementia, and no cognitive impairment: an exploratory study. Eur Geriatr Med 2021; 12:1257-1265. [PMID: 34156656 PMCID: PMC8626373 DOI: 10.1007/s41999-021-00521-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022]
Abstract
Aim To investigate performance of the Months of the Year Backwards (MOTYB) test in older hospitalised patients with delirium, dementia, and no cognitive impairment. Findings Half of the patients with delirium (46%) could not engage with MOTYB compared to only 11% of patients with dementia without delirium. In patients able to give responses, those with delirium or dementia performed significantly worse than those without cognitive impairment. Message Our findings show the potential value of analysing response patterns, especially initial engagement, self-correction, and ability to continue to do the task in addition to considering exclusively the capacity to correctly recite the months until July, June or January. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00521-4. Purpose To investigate performance of the Months of the Year Backwards (MOTYB) test in older hospitalised patients with delirium, dementia, and no cognitive impairment. Methods Secondary analysis of data from a case–control study of 149 hospitalised patients aged ≥ 65 years with delirium [with or without dementia (N = 50)], dementia [without delirium (N = 46)], and no cognitive impairment (N = 53). Verbatim transcripts of MOTYB audio recordings were analysed to determine group differences in response patterns. Results In the total sample [median age 85y (IQR 80–88), 82% female], patients with delirium were more often unable to recite months backward to November (36/50 = 72%) than patients with dementia (21/46 = 46%; p < 0.01) and both differed significantly from patients without cognitive impairment (2/53 = 4%; p’s < 0.001). 121/149 (81%) of patients were able to engage with the test. Patients with delirium were more often unable to engage with MOTYB (23/50 = 46%; e.g., due to reduced arousal) than patients with dementia (5/46 = 11%; p < 0.001); both groups differed significantly (p’s < 0.001) from patients without cognitive impairment (0/53 = 0%). There was no statistically significant difference between patients with delirium (2/27 = 7%) and patients with dementia (8/41 = 20%) in completing MOTYB to January, but performance in both groups differed (p < 0.001 and p < 0.02, respectively) from patients without cognitive impairment (35/53 = 66%). Conclusion Delirium was associated with inability to engage with MOTYB and low rates of completion. In patients able to engage with the test, error-free completion rates were low in delirium and dementia. Recording of engagement and patterns of errors may add useful information to MOTYB scoring. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00521-4.
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Affiliation(s)
- Wolfgang Hasemann
- University Department of Geriatric Medicine FELIX PLATTER Basel, Burgfelderstrasse, 101 4055, Basel, Switzerland. .,Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
| | - Nikki Duncan
- Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Caoimhe Clarke
- Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Eva Nouzova
- Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lisa-Marie Süßenbach
- Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher, University of Edinburgh, Edinburgh, Scotland, UK
| | - Valentina Assi
- Edinburgh Clinical Trials Unit, Usher, University of Edinburgh, Edinburgh, Scotland, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Tim Walsh
- Dept of Critical Care Medicine and Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland, UK
| | - Elizabeth Wilson
- Dept of Critical Care Medicine and Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Tara Quasim
- Anaesthesia, Critical Care and Pain Medicine, University of Glasgow, Glasgow, Scotland, UK
| | - Duncan Middleton
- Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, UK
| | - Alexander J Weir
- Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, UK
| | | | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Alasdair M J MacLullich
- Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Zoë Tieges
- Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.,SMART Technology Centre, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, Scotland, UK
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5
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Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely EW. Delirium. Nat Rev Dis Primers 2020; 6:90. [PMID: 33184265 PMCID: PMC9012267 DOI: 10.1038/s41572-020-00223-4] [Citation(s) in RCA: 394] [Impact Index Per Article: 98.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
Delirium, a syndrome characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) is the most commonly used diagnostic system upon which a reference standard diagnosis is made, although many other delirium screening tools have been developed given the impracticality of using the DSM-5 in many settings. Pharmacological treatments for delirium (such as antipsychotic drugs) are not effective, reflecting substantial gaps in our understanding of its pathophysiology. Currently, the best management strategies are multidomain interventions that focus on treating precipitating conditions, medication review, managing distress, mitigating complications and maintaining engagement to environmental issues. The effective implementation of delirium detection, treatment and prevention strategies remains a major challenge for health-care organizations globally.
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Affiliation(s)
- Jo Ellen Wilson
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS), Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychiatry and Behavioral Sciences, Division of General Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Matthew F Mart
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS), Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Colm Cunningham
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Republic of Ireland
| | - Yahya Shehabi
- Monash Health School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Prince of Wales Clinical School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy D Girard
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS), Vanderbilt University Medical Center, Nashville, TN, USA
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alasdair M J MacLullich
- Edinburgh Delirium Research Group, Geriatric Medicine, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - E Wesley Ely
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS), Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Veteran's Affairs TN Valley, Geriatrics Research, Education and Clinical Center (GRECC), Nashville, TN, USA
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