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Predictors of delirium in older patients at the emergency department: a prospective multicentre derivation study

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Abstract

Objective

The objective of this study was to identify the predictors of incident delirium in this high-risk population.

Methods

This study was a planned sub-analysis of the INDEED multicentre cohort study. We recruited patients aged ≥ 65, independent/semi-independent, with an emergency department (ED) length of stay ≥ 8 h and admitted to any hospital ward. Patients were followed up during their ED stay up to 24 h after ward admission. Sociodemographic characteristics, comorbidities, functional status (OARS), illness severity, level of frailty, cognitive status (TICS-m) and ED/patient environment evaluation were collected during initial interview. Patients were screened for delirium twice a day using the Confusion Assessment Method. Multivariate logistic regression was performed to identify the predictors of delirium.

Results

Incident delirium was detected in 68 patients of the 612 patients included (11%). Initially, seven candidate predictors were included in a regression model, of which four were retained using a stepwise selection procedure. Presence of cognitive impairment at baseline (OR 3.6, p < 0.001), absence of mobilization during the whole ED length of stay (OR 3.3, p = 0.002), longer ED length of stay (OR 1.02, p = 0.006) were associated with a higher risk of incident delirium while higher functional status was associated with a lower risk (OR 0.8, p < 0.001).

Conclusion

More work is needed to determine which tool(s) are most appropriate for the ED use to increase delirium screening compliance among health professionals working in this department. It is really the first step to be able to suggest interventions to decrease delirium incidence.

Résumé

Objectif

L'objectif de cette étude était d'identifier les prédicteurs du délirium incident dans cette population à hautrisque.

Méthodes

Cette étude était une sous-analyse planifiée de l'étude de cohorte multicentrique INDEED. Nous avons recruté des patients âgés de ≥ 65 ans, indépendants/semi-indépendants, ayant une durée de séjour au département d'urgence (DU) ≥ 8 h et admis dans n'importe quel service. Les patients ont été suivis pendant leur séjour aux urgences jusqu'à 24 h après leur admission. Les caractéristiques sociodémographiques, les comorbidités, l'état fonctionnel (OARS), la gravité de la maladie, le niveau de fragilité, l'état cognitif (TICS-m) et l'évaluation de l'environnement des urgences/patients ont été recueillis lors de l'entretien initial. Les patients ont été soumis à un dépistage du délirium deux fois par jour à l'aide de la méthode d'évaluation de la confusion. Une régression logistique multivariée a été effectuée pour identifier les prédicteurs de délirium.

Résultats

Le délirium incident a été détecté chez 68 des 612 patients inclus (11%). Au départ, sept prédicteurs candidats ont été inclus dans un modèle de régression, dont quatre ont été retenus par une procédure de sélection par étapes. La présence d'un déficit cognitif initial (RC 3,6, p < 0,001), l'absence de mobilisation pendant toute la durée du séjour à l'urgence (RC 3,3, p = 0,002), une durée de séjour plus longue à l'urgence (RC 1,02, p = 0,006) étaient associées à un risque plus élevé de délirium incident, tandis qu'un état fonctionnel plus élevé était associé à un risque plus faible (RC 0,8, p < 0,001).

Conclusions

Des travaux supplémentaires sont nécessaires pour déterminer quel(s) outil(s) sont les plus appropriés au DU afin d'accroître le dépistage du délirium par les professionnels de santé travaillant dans ce service. C'est vraiment la première étape pour pouvoir proposer des interventions visant à diminuer l'incidence du délirium.

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Acknowledgements

The authors would like to thank Suzy Lavoie and research assistants who participated in the recruitment of patients for this study.

Funding

This study was funded by the Fonds Québécois de Recherche en Santé (FQRS 29307).

Author information

Authors and Affiliations

  1. Université Laval, Québec, Canada

    Emmanuelle Béland, Philippe Voyer, Mathieu Pelletier, Simon Berthelot, Marie-Eve Lamontagne, Michèle Morin, Stéphane Lemire & Marcel Émond

  2. Centre de Recherche du CHU de Québec-Université Laval, Hôpital de L’Enfant-Jésus, Québec, Canada

    Alexandra Nadeau, Valérie Boucher, Philippe Voyer, Simon Berthelot, Michèle Morin, Stéphane Lemire & Marcel Émond

  3. Centre D’excellence Sur Le Vieillissement de Québec, Québec, Canada

    Pierre-Hugues Carmichael

  4. Centre Intégré de Santé Et de Services Sociaux de Lanaudière, Joliette, Canada

    Mathieu Pelletier

  5. Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada

    Émilie Gouin

  6. Centre de Recherche de L’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada

    Raoul Daoust

  7. Université de Montréal, Montréal, Canada

    Raoul Daoust & Thien Tuong Minh Vu

  8. Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale, Québec, Canada

    Marie-Eve Lamontagne

  9. Centre de Recherche du Centre Hospitalier de L’Université de Montréal, Montréal, Canada

    Thien Tuong Minh Vu

Authors
  1. Emmanuelle Béland
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  2. Alexandra Nadeau
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  3. Pierre-Hugues Carmichael
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  4. Valérie Boucher
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  5. Philippe Voyer
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  6. Mathieu Pelletier
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  7. Émilie Gouin
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  8. Raoul Daoust
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  9. Simon Berthelot
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  10. Marie-Eve Lamontagne
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  11. Michèle Morin
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  12. Stéphane Lemire
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  13. Thien Tuong Minh Vu
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  14. Marcel Émond
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Contributions

MÉ had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He was responsible for design, funding and conduct of the study. VB managed the study. EB, AN and PHC led the statistical analyses and data interpretations. EB and AN wrote the manuscript. MP, RD, ÉG, SB and MÉ were responsible for recruitment at all five sites. PV, MM, SL, MÈL and LM are all collaborators of INDEED project. MÉ, VB, PHC, PV, MP, ÉG, RD, SB, MÈL, MM, and SL reviewed and approved the manuscript. Sponsor’s role. N/A.

Corresponding author

Correspondence to Marcel Émond.

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Béland, E., Nadeau, A., Carmichael, PH. et al. Predictors of delirium in older patients at the emergency department: a prospective multicentre derivation study. Can J Emerg Med 23, 330–336 (2021). https://doi.org/10.1007/s43678-020-00004-8

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  • DOI: https://doi.org/10.1007/s43678-020-00004-8

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