TY - JOUR
T1 - "Delirium Day"
T2 - A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool
AU - Bellelli, Giuseppe
AU - Morandi, Alessandro
AU - Di Santo, Simona G.
AU - Mazzone, Andrea
AU - Cherubini, Antonio
AU - Mossello, Enrico
AU - Bo, Mario
AU - Bianchetti, Angelo
AU - Rozzini, Renzo
AU - Zanetti, Ermellina
AU - Musicco, Massimo
AU - Ferrari, Alberto
AU - Ferrara, Nicola
AU - Trabucchi, Marco
AU - Boffelli, Stefano
AU - Stefano, Fabio Di
AU - Filippi, Francesco De
AU - Guerini, Fabio
AU - Bertoletti, Erik
AU - March, Albert
AU - Margiotta, Alessandro
AU - Mecocci, Patrizia
AU - Addesi, Desireè
AU - Fantò, Fausto
AU - Dijik, Babette
AU - Porrino, Paola
AU - Cotroneo, Antonino Maria
AU - Galli, Giovanni
AU - Bruni, Amalia Cecilia
AU - Bernardini, Bruno
AU - Corsini, Carla
AU - Cagnin, Annachiara
AU - Zurlo, Amedeo
AU - Barbagallo, Giuseppe
AU - Lunardelli, Maria Lia
AU - Martini, Emilio
AU - Battaglia, Giuseppe
AU - Latella, Raffaele
AU - Petritola, Donatella
AU - Sinforiani, Elena
AU - Cester, Alberto
AU - Formilan, Marino
AU - Carbone, Pasqualina
AU - Appollonio, Ildebrando
AU - Cereda, Diletta
AU - Tremolizzo, Lucio
AU - Mari, Daniela
AU - Scarpini, Elio
AU - Dell'Aquila, Giuseppina
AU - Avanzi, Stefano
AU - on behalf of the Italian Study Group on Delirium (ISGoD)
PY - 2016/7/18
Y1 - 2016/7/18
N2 - Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.
AB - Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.
KW - 4AT
KW - Delirium
KW - Hospital
KW - Multicenter
KW - Prevalence
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U2 - 10.1186/s12916-016-0649-8
DO - 10.1186/s12916-016-0649-8
M3 - Article
AN - SCOPUS:84978827758
VL - 14
JO - BMC Medicine
JF - BMC Medicine
SN - 1741-7015
IS - 1
M1 - 106
ER -