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MP09: Incidence of emergency department induced delirium: a Canadian two years prospective study

Published online by Cambridge University Press:  11 May 2018

M. Emond*
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
A. Nadeau
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
V. Boucher
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
P. Voyer
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
M. Pelletier
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
E. Gouin
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
R. Daoust
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
S. Berthelot
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
M. Lamontagne
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
M. Morin
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
S. Lemire
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
T. Minh Vu
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
M. Rheault
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
L. Juneau
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
N. Le Sage
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
J. Lee
Affiliation:
Université Laval, Department of Emergency Medicine, Laval, PQ
*
*Corresponding author

Abstract

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Introduction: Prevalence and incidence of delirium in older patients admitted to acute and long-term care facilities ranges between 9.6% and 89% but little is known in the context of emergency department (ED) incident delirium. Literature regarding the incidence of delirium in the ED and its potential impacts on hospital length of stay (LOS), functional status and unplanned ED readmissions is scant, its consequences have yet to be clearly identified in order to orient modern acute medical care. Methods: This study is part of the multicenter prospective cohort INDEED study. Three Canadian EDs completed the two years prospective study (March-July 2015 and Feb-May 2016). Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Patients were assessed 2x/day during their entire ED stay and up to 24 hours on hospital ward by research assistants (RA). The primary outcome of this study was incident delirium in the ED or within 24 h of ward admission. Functional and cognitive status were assessed using validated Older Americans’ Resources and Services and the Telephone Interview for Cognitive Status- modified tools. The Confusion Assessment Method (CAM) was used to detect incident delirium. ED and hospital administrative data were collected. Inter-observer agreement was realized among RA. Results: Incident delirium was not different between sites, nor between phases, nor between times from one site to another. All phases confounded, there is between 7 to 11% of ED related incident delirious episodes. Differences were seen in ED LOS between sites in non-delirious patients, but also between some sites for delirious participants (p<0.05). Only one site had a difference in ED LOS between their delirious and non-delirious patients, respectively of 52.1 and 40.1 hours (p<0.05). There is also a difference between sites in the time between arrival to the ED and the incidence of delirium (p=0.003). Kappa statistics were computed to measure inter-rater reliability of the CAM. Based on an alpha of 5%, 138 patients would allow 80% power for an estimated overall incidence proportion of 15 % with 5% precision.. Other predictive delirium variables, such as cognitive status, environmental factors, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between sites and phases. Conclusion: The fact that incidence of delirium was the same for all sites, despite the differences of ED LOS and different time periods suggest that many other modifiable and non-modifiable factors along LOS influenced the incidence of ED induced delirium. Emergency physician should concentrate on improving senior-friendly environment for the ED.

Type
Moderated Posters Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2018