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10.1111/j.1553-2712.2008.00339.x http://scihub22266oqcxt.onion/10.1111/j.1553-2712.2008.00339.x C5015887!5015887!19154565     free     free     free Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Acad+Emerg+Med 2009 ; 16 (3): 193-200 Nephropedia Template TP {{tp|p=19154565|t=2009. Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes |pdf=|usr=}}{{19154565}} gab.com Text Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes JO: Acad Emerg Med http://www.kidney.de/pget.php?&tw=1&pmid=19154565 #FOAvip Objectives: Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians. Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by emergency physicians. We sought 1) to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, 2) to identify delirium risk factors in older ED patients, and 3) to characterize delirium by psychomotor subtypes in the ED setting. Methods: This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes. Results: Inclusion and exclusion criteria were met in 303 patients and 25 (8.3%) presented to the ED with delirium. The vast majority (92.0%, 95%CI: 74.0% - 99.0%) of delirious patients had the hypoactive psychomotor subtype. Of the 25 patients with delirium, 19 (76.0%, 95%CI: 54.9% - 90.6%) were not recognized to be delirious by the emergency physician. Of the 16 admitted delirious patients who were undiagnosed by the emergency physicians, 15 (93.8%, 95%CI: 69.8% - 99.8%) remained unrecognized by the hospital physician at the time of admission. Dementia, a Katz ADL ? 4, and hearing impairment were independently associated with presenting with delirium in the ED. Based upon the multivariable model, a delirium risk score was constructed. Dementia, Katz ADL ? 4, and hearing impairment were weighted equally. Patients with higher risk score more likely to be CAM-ICU positive (area under the receiver operating characteristic curve = 0.82). If older ED patients with one or more delirium risk factors were screened for delirium, 165 (54.5%, 95%CI: 48.7% to 60.2%) would have required a delirium assessment at the expense of missing one patient with delirium, while screening 141 patients without delirium. Conclusion: Delirium was a common occurrence in the ED and the vast majority of delirium in the ED was the hypoactive subtype. Emergency physicians missed delirium in 76% of the cases. Delirium that was missed in the ED was nearly always missed by hospital physicians at the time of admission. Using a delirium risk score has the potential to improve delirium screening efficiency in the ED setting. Twit Text FOAVip Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes ????Acad Emerg Med http://www.kidney.de/pget.php?&tw=1&pmid=19154565 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=19154565 #FOAvip English Wikipedia <ref>{{Cite pmid|19154565}}</ref> Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes #MMPMID19154565 Han JH; Zimmerman EE; Cutler N; Schnelle J; Morandi A; Dittus RS; Storrow AB; Ely EW Acad Emerg Med 2009[Mar]; 16 (3): 193-200 PMID19154565show ga Objectives: Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians. Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by emergency physicians. We sought 1) to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, 2) to identify delirium risk factors in older ED patients, and 3) to characterize delirium by psychomotor subtypes in the ED setting. Methods: This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes. Results: Inclusion and exclusion criteria were met in 303 patients and 25 (8.3%) presented to the ED with delirium. The vast majority (92.0%, 95%CI: 74.0% - 99.0%) of delirious patients had the hypoactive psychomotor subtype. Of the 25 patients with delirium, 19 (76.0%, 95%CI: 54.9% - 90.6%) were not recognized to be delirious by the emergency physician. Of the 16 admitted delirious patients who were undiagnosed by the emergency physicians, 15 (93.8%, 95%CI: 69.8% - 99.8%) remained unrecognized by the hospital physician at the time of admission. Dementia, a Katz ADL ? 4, and hearing impairment were independently associated with presenting with delirium in the ED. Based upon the multivariable model, a delirium risk score was constructed. Dementia, Katz ADL ? 4, and hearing impairment were weighted equally. Patients with higher risk score more likely to be CAM-ICU positive (area under the receiver operating characteristic curve = 0.82). If older ED patients with one or more delirium risk factors were screened for delirium, 165 (54.5%, 95%CI: 48.7% to 60.2%) would have required a delirium assessment at the expense of missing one patient with delirium, while screening 141 patients without delirium. Conclusion: Delirium was a common occurrence in the ED and the vast majority of delirium in the ED was the hypoactive subtype. Emergency physicians missed delirium in 76% of the cases. Delirium that was missed in the ED was nearly always missed by hospital physicians at the time of admission. Using a delirium risk score has the potential to improve delirium screening efficiency in the ED setting. äDelirium in Older Emergency Department Patients: Recognition, Risk Fac(epmc).pdf DeepDyve Pubget Overpricing