Dataset Information

Can delirium research activity impact on routine delirium recognition? A prospective cohort study.

ABSTRACT:

Objective

To assess if ongoing delirium research activity within an acute admissions unit impacts on prevalent delirium recognition.

Design

Prospective cohort study.

Setting

Single-site tertiary university teaching hospital.

Participants

125 patients with delirium, as diagnosed by an expert using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition reference criteria, were recruited to a prospective cohort study investigating use of informant tools to detect unrecognised dementia. This study evaluated recognition of delirium and documentation of delirium by medical staff.

Interventions

The main study followed an observational design; the intervention discussed was the implementation of this study itself.

Primary and secondary outcome measures

The primary outcome was recognition of delirium by the admitting medical team prior to study diagnosis. Secondary outcomes included recording of or description of delirium in discharge summaries, and factors which may be associated with unrecognised delirium.

Results

Delirium recognition improved between the first half (48%) and second half (71%) of recruitment (p=0.01). There was no difference in recording of delirium or description of delirium in the text of discharge summaries.

Conclusion

Delirium research activity can improve recognition of delirium. This has the potential to improve patient outcomes.

SUBMITTER: Welch C

PROVIDER: S-EPMC6252640 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Can delirium research activity impact on routine delirium recognition? A prospective cohort study.

Welch Carly C Jackson Thomas A TA

BMJ open 20181031 10

<h4>Objective</h4>To assess if ongoing delirium research activity within an acute admissions unit impacts on prevalent delirium recognition.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Single-site tertiary university teaching hospital.<h4>Participants</h4>125 patients with delirium, as diagnosed by an expert using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition reference criteria, were recruited to a prospective cohort study investigating use of informant tools t ...[more]

PMID: 30385447

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Project description:OBJECTIVES:Catatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia. DESIGN:Convenience cohort, nested within two ongoing randomized trials. SETTING:Single academic medical center in Nashville, TN. PATIENTS:We enrolled 136 critically ill patients on mechanical ventilation and/or vasopressors, randomized to two usual care sedation regimens. MEASUREMENTS AND MAIN RESULTS:Patients were assessed for delirium and catatonia by independent and masked personnel using Confusion Assessment Method for the ICU and the Bush Francis Catatonia Rating Scale mapped to Diagnostic Statistical Manual 5 criterion A for catatonia. Of 136 patients, 58 patients (43%) had only delirium, four (3%) had only catatonia, 42 (31%) had both, and 32 (24%) had neither. In a logistic regression model, more catatonia signs were associated with greater odds of having delirium. For example, patient assessments with greater than or equal to three Diagnostic Statistical Manual 5 symptoms (75th percentile) had, on average, 27.8 times the odds (interquartile range, 12.7-60.6) of having delirium compared with patient assessments with zero Diagnostic Statistical Manual 5 criteria (25th percentile) present (p < 0.001). A cut-off of greater than or equal to 4 Bush Francis Catatonia Screening Instrument items was both sensitive (91%; 95% CI, 82.9-95.3) and specific (91%; 95% CI, 87.6-92.9) for Diagnostic Statistical Manual 5 catatonia. CONCLUSIONS:Given that about one in three patients had both catatonia and delirium, these data prompt reconsideration of Diagnostic Statistical Manual 5 criteria for "Catatonic Disorder Due to Another Medical Condition" that preclude diagnosing catatonia in the presence of delirium.

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Dataset Information

Can delirium research activity impact on routine delirium recognition? A prospective cohort study.

Objective

Design

Setting

Participants

Interventions

Primary and secondary outcome measures

Results

Conclusion

Publications

Can delirium research activity impact on routine delirium recognition? A prospective cohort study.

Similar Datasets

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