1
|
Émond M, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Minh Vu TT, Nadeau A, Rheault M, Juneau L, Le Sage N, Lee J. Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study. BMJ Open 2018. [PMID: 29523559 PMCID: PMC5855334 DOI: 10.1136/bmjopen-2017-018190] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING The study took place in four Canadian EDs. PARTICIPANTS 338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent. MAIN OUTCOMES AND MEASURES The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes. RESULTS Mean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5-47.9) hours and hospital LOS was 146.6 (75.2-267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient. CONCLUSIONS An incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.
Collapse
Affiliation(s)
- Marcel Émond
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Philippe Voyer
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Nursing, Université Laval, Québec, Canada
| | - Mathieu Pelletier
- Medicine, Université Laval, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Medicine, Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Medicine, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Stéphane Lemire
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Thien Tuong Minh Vu
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Institut de gériatrie de l’Université de Montréal, Montréal, Canada
| | - Alexandra Nadeau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Lucille Juneau
- Centre Intégré Universitaire de Services Sociaux et de Santé de la Capitale-Nationale, Québec, Canada
| | - Natalie Le Sage
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
| |
Collapse
|