"Delirium Day"

A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

G. Bellelli, A. Morandi, Simona Gabriella Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, A. Bianchetti, R. Rozzini, Ermellina Zanetti, Massimo Musicco, A. Ferrari, Nicola Ferrara, M. Trabucchi, S. Boffelli, Fabio Di Stefano, Francesco De Filippi, F. Guerini, Erik Bertoletti, Albert March & 103 others Alessandro Margiotta, Patrizia Mecocci, Desireè Addesi, F. Fantò, Babette Dijik, Paola Porrino, A. Cotroneo, Giovanni Galli, Amalia Cecilia Bruni, B. Bernardini, C. Corsini, Annachiara Cagnin, Amedeo Zurlo, Giuseppe Barbagallo, Maria Lia Lunardelli, E. Martini, Giuseppe Battaglia, Raffaele Latella, Donatella Petritola, Elena Sinforiani, A. Cester, M. Formilan, Pasqualina Carbone, I. M. Appollonio, Diletta Cereda, Lucio Tremolizzo, E. Bottacchi, Lucio Lucchetti, Claudio Mariani, Piero Rapazzini, Giuseppe Romanelli, A. Marengoni, Giovanni Zuliani, Lara Bianchi, Teresa Suardi, Ettore Muti, Renato Bottura, Giovanni Sgrò, Antonella Mandas, Luca Serchisu, Patrizia Crippa, Claudio Ivaldi, Andrea Ungar, Daniele Villani, Clara Raimondi, Chiara Mussi, Giancarlo Isaia, Giuseppe Provenzano, Daniela Mari, P. Odetti, Fiammetta Monacelli, R. Antonelli Incalzi, Alice Pluderi, Claudio Bellamoli, Luciano Terranova, Elio Angelo Scarpini, Ferdinando D'Amico, Maria Chiara Cavallini, Gianbattista Guerrini, AnnaMaria Scotuzzi, Antonino Chiarello, A. Pilotto, Sara Tognini, Giuseppina Dell'Aquila, G. Toigo, Giuliano Ceschia, Maristella Piccinini, A. Fabbo, Marco Zoli, P. Forti, Christian Wenter, Giorgio Basile, Anna Lasagni, A. Padovani, L. Rozzini, Maria Cottino, S. Vitali, G. Tripi, Stefano Avanzi, Giorgio Annoni, Giovanni Ruotolo, Federica Boschi, Paolo Bonino, Niccolò Marchionni, Sara Fascendini, Gabriele Noro, Renato Turco, M. C. Ubezio, C. Serrati, Maria Infante, Simona Gentile, Luigi M. Pernigotti, Carlo A. Biagini, Enzo Canonico, Pietro Bonati, Pietro Gareri, Paolo Caffarra, Arcangelo Ceretti, Rosanna Castiglia, Carlo Gabelli, Mario Lo Storto, P. Putzu, Simona Di Santo

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article number106
JournalBMC Medicine
Volume14
Issue number1
DOIs
Publication statusPublished - Jul 18 2016

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Delirium
Cross-Sectional Studies
Odds Ratio
Confidence Intervals
Rehabilitation
Neurology
Physical Restraint
Urinary Catheters
Enteral Nutrition
Dementia
Population
Benchmarking
Activities of Daily Living
Internal Medicine
Nutritional Status
Malnutrition
Geriatrics
Italy
Antipsychotic Agents
Multicenter Studies

Keywords

  • 4AT
  • Delirium
  • Hospital
  • Multicenter
  • Prevalence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

"Delirium Day" : A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. / Bellelli, G.; Morandi, A.; Di Santo, Simona Gabriella; Mazzone, Andrea; Cherubini, Antonio; Mossello, Enrico; Bo, Mario; Bianchetti, A.; Rozzini, R.; Zanetti, Ermellina; Musicco, Massimo; Ferrari, A.; Ferrara, Nicola; Trabucchi, M.; Boffelli, S.; Stefano, Fabio Di; Filippi, Francesco De; Guerini, F.; Bertoletti, Erik; March, Albert; Margiotta, Alessandro; Mecocci, Patrizia; Addesi, Desireè; Fantò, F.; Dijik, Babette; Porrino, Paola; Cotroneo, A.; Galli, Giovanni; Bruni, Amalia Cecilia; Bernardini, B.; Corsini, C.; Cagnin, Annachiara; Zurlo, Amedeo; Barbagallo, Giuseppe; Lunardelli, Maria Lia; Martini, E.; Battaglia, Giuseppe; Latella, Raffaele; Petritola, Donatella; Sinforiani, Elena; Cester, A.; Formilan, M.; Carbone, Pasqualina; Appollonio, I. M.; Cereda, Diletta; Tremolizzo, Lucio; Bottacchi, E.; Lucchetti, Lucio; Mariani, Claudio; Rapazzini, Piero; Romanelli, Giuseppe; Marengoni, A.; Zuliani, Giovanni; Bianchi, Lara; Suardi, Teresa; Muti, Ettore; Bottura, Renato; Sgrò, Giovanni; Mandas, Antonella; Serchisu, Luca; Crippa, Patrizia; Ivaldi, Claudio; Ungar, Andrea; Villani, Daniele; Raimondi, Clara; Mussi, Chiara; Isaia, Giancarlo; Provenzano, Giuseppe; Mari, Daniela; Odetti, P.; Monacelli, Fiammetta; Antonelli Incalzi, R.; Pluderi, Alice; Bellamoli, Claudio; Terranova, Luciano; Scarpini, Elio Angelo; D'Amico, Ferdinando; Cavallini, Maria Chiara; Guerrini, Gianbattista; Scotuzzi, AnnaMaria; Chiarello, Antonino; Pilotto, A.; Tognini, Sara; Dell'Aquila, Giuseppina; Toigo, G.; Ceschia, Giuliano; Piccinini, Maristella; Fabbo, A.; Zoli, Marco; Forti, P.; Wenter, Christian; Basile, Giorgio; Lasagni, Anna; Padovani, A.; Rozzini, L.; Cottino, Maria; Vitali, S.; Tripi, G.; Avanzi, Stefano; Annoni, Giorgio; Ruotolo, Giovanni; Boschi, Federica; Bonino, Paolo; Marchionni, Niccolò; Fascendini, Sara; Noro, Gabriele; Turco, Renato; Ubezio, M. C.; Serrati, C.; Infante, Maria; Gentile, Simona; Pernigotti, Luigi M.; Biagini, Carlo A.; Canonico, Enzo; Bonati, Pietro; Gareri, Pietro; Caffarra, Paolo; Ceretti, Arcangelo; Castiglia, Rosanna; Gabelli, Carlo; Storto, Mario Lo; Putzu, P.; Santo, Simona Di.

In: BMC Medicine, Vol. 14, No. 1, 106, 18.07.2016.

Research output: Contribution to journalArticle

Bellelli, G, Morandi, A, Di Santo, SG, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Bianchetti, A, Rozzini, R, Zanetti, E, Musicco, M, Ferrari, A, Ferrara, N, Trabucchi, M, Boffelli, S, Stefano, FD, Filippi, FD, Guerini, F, Bertoletti, E, March, A, Margiotta, A, Mecocci, P, Addesi, D, Fantò, F, Dijik, B, Porrino, P, Cotroneo, A, Galli, G, Bruni, AC, Bernardini, B, Corsini, C, Cagnin, A, Zurlo, A, Barbagallo, G, Lunardelli, ML, Martini, E, Battaglia, G, Latella, R, Petritola, D, Sinforiani, E, Cester, A, Formilan, M, Carbone, P, Appollonio, IM, Cereda, D, Tremolizzo, L, Bottacchi, E, Lucchetti, L, Mariani, C, Rapazzini, P, Romanelli, G, Marengoni, A, Zuliani, G, Bianchi, L, Suardi, T, Muti, E, Bottura, R, Sgrò, G, Mandas, A, Serchisu, L, Crippa, P, Ivaldi, C, Ungar, A, Villani, D, Raimondi, C, Mussi, C, Isaia, G, Provenzano, G, Mari, D, Odetti, P, Monacelli, F, Antonelli Incalzi, R, Pluderi, A, Bellamoli, C, Terranova, L, Scarpini, EA, D'Amico, F, Cavallini, MC, Guerrini, G, Scotuzzi, A, Chiarello, A, Pilotto, A, Tognini, S, Dell'Aquila, G, Toigo, G, Ceschia, G, Piccinini, M, Fabbo, A, Zoli, M, Forti, P, Wenter, C, Basile, G, Lasagni, A, Padovani, A, Rozzini, L, Cottino, M, Vitali, S, Tripi, G, Avanzi, S, Annoni, G, Ruotolo, G, Boschi, F, Bonino, P, Marchionni, N, Fascendini, S, Noro, G, Turco, R, Ubezio, MC, Serrati, C, Infante, M, Gentile, S, Pernigotti, LM, Biagini, CA, Canonico, E, Bonati, P, Gareri, P, Caffarra, P, Ceretti, A, Castiglia, R, Gabelli, C, Storto, ML, Putzu, P & Santo, SD 2016, '"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool', BMC Medicine, vol. 14, no. 1, 106. https://doi.org/10.1186/s12916-016-0649-8
Bellelli, G. ; Morandi, A. ; Di Santo, Simona Gabriella ; Mazzone, Andrea ; Cherubini, Antonio ; Mossello, Enrico ; Bo, Mario ; Bianchetti, A. ; Rozzini, R. ; Zanetti, Ermellina ; Musicco, Massimo ; Ferrari, A. ; Ferrara, Nicola ; Trabucchi, M. ; Boffelli, S. ; Stefano, Fabio Di ; Filippi, Francesco De ; Guerini, F. ; Bertoletti, Erik ; March, Albert ; Margiotta, Alessandro ; Mecocci, Patrizia ; Addesi, Desireè ; Fantò, F. ; Dijik, Babette ; Porrino, Paola ; Cotroneo, A. ; Galli, Giovanni ; Bruni, Amalia Cecilia ; Bernardini, B. ; Corsini, C. ; Cagnin, Annachiara ; Zurlo, Amedeo ; Barbagallo, Giuseppe ; Lunardelli, Maria Lia ; Martini, E. ; Battaglia, Giuseppe ; Latella, Raffaele ; Petritola, Donatella ; Sinforiani, Elena ; Cester, A. ; Formilan, M. ; Carbone, Pasqualina ; Appollonio, I. M. ; Cereda, Diletta ; Tremolizzo, Lucio ; Bottacchi, E. ; Lucchetti, Lucio ; Mariani, Claudio ; Rapazzini, Piero ; Romanelli, Giuseppe ; Marengoni, A. ; Zuliani, Giovanni ; Bianchi, Lara ; Suardi, Teresa ; Muti, Ettore ; Bottura, Renato ; Sgrò, Giovanni ; Mandas, Antonella ; Serchisu, Luca ; Crippa, Patrizia ; Ivaldi, Claudio ; Ungar, Andrea ; Villani, Daniele ; Raimondi, Clara ; Mussi, Chiara ; Isaia, Giancarlo ; Provenzano, Giuseppe ; Mari, Daniela ; Odetti, P. ; Monacelli, Fiammetta ; Antonelli Incalzi, R. ; Pluderi, Alice ; Bellamoli, Claudio ; Terranova, Luciano ; Scarpini, Elio Angelo ; D'Amico, Ferdinando ; Cavallini, Maria Chiara ; Guerrini, Gianbattista ; Scotuzzi, AnnaMaria ; Chiarello, Antonino ; Pilotto, A. ; Tognini, Sara ; Dell'Aquila, Giuseppina ; Toigo, G. ; Ceschia, Giuliano ; Piccinini, Maristella ; Fabbo, A. ; Zoli, Marco ; Forti, P. ; Wenter, Christian ; Basile, Giorgio ; Lasagni, Anna ; Padovani, A. ; Rozzini, L. ; Cottino, Maria ; Vitali, S. ; Tripi, G. ; Avanzi, Stefano ; Annoni, Giorgio ; Ruotolo, Giovanni ; Boschi, Federica ; Bonino, Paolo ; Marchionni, Niccolò ; Fascendini, Sara ; Noro, Gabriele ; Turco, Renato ; Ubezio, M. C. ; Serrati, C. ; Infante, Maria ; Gentile, Simona ; Pernigotti, Luigi M. ; Biagini, Carlo A. ; Canonico, Enzo ; Bonati, Pietro ; Gareri, Pietro ; Caffarra, Paolo ; Ceretti, Arcangelo ; Castiglia, Rosanna ; Gabelli, Carlo ; Storto, Mario Lo ; Putzu, P. ; Santo, Simona Di. / "Delirium Day" : A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. In: BMC Medicine. 2016 ; Vol. 14, No. 1.
@article{1a654af01ca4498aa3b7cd1ab4a61927,
title = "{"}Delirium Day{"}: A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool",
abstract = "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.",
keywords = "4AT, Delirium, Hospital, Multicenter, Prevalence",
author = "G. Bellelli and A. Morandi and {Di Santo}, {Simona Gabriella} and Andrea Mazzone and Antonio Cherubini and Enrico Mossello and Mario Bo and A. Bianchetti and R. Rozzini and Ermellina Zanetti and Massimo Musicco and A. Ferrari and Nicola Ferrara and M. Trabucchi and S. Boffelli and Stefano, {Fabio Di} and Filippi, {Francesco De} and F. Guerini and Erik Bertoletti and Albert March and Alessandro Margiotta and Patrizia Mecocci and Desire{\`e} Addesi and F. Fant{\`o} and Babette Dijik and Paola Porrino and A. Cotroneo and Giovanni Galli and Bruni, {Amalia Cecilia} and B. Bernardini and C. Corsini and Annachiara Cagnin and Amedeo Zurlo and Giuseppe Barbagallo and Lunardelli, {Maria Lia} and E. Martini and Giuseppe Battaglia and Raffaele Latella and Donatella Petritola and Elena Sinforiani and A. Cester and M. Formilan and Pasqualina Carbone and Appollonio, {I. M.} and Diletta Cereda and Lucio Tremolizzo and E. Bottacchi and Lucio Lucchetti and Claudio Mariani and Piero Rapazzini and Giuseppe Romanelli and A. Marengoni and Giovanni Zuliani and Lara Bianchi and Teresa Suardi and Ettore Muti and Renato Bottura and Giovanni Sgr{\`o} and Antonella Mandas and Luca Serchisu and Patrizia Crippa and Claudio Ivaldi and Andrea Ungar and Daniele Villani and Clara Raimondi and Chiara Mussi and Giancarlo Isaia and Giuseppe Provenzano and Daniela Mari and P. Odetti and Fiammetta Monacelli and {Antonelli Incalzi}, R. and Alice Pluderi and Claudio Bellamoli and Luciano Terranova and Scarpini, {Elio Angelo} and Ferdinando D'Amico and Cavallini, {Maria Chiara} and Gianbattista Guerrini and AnnaMaria Scotuzzi and Antonino Chiarello and A. Pilotto and Sara Tognini and Giuseppina Dell'Aquila and G. Toigo and Giuliano Ceschia and Maristella Piccinini and A. Fabbo and Marco Zoli and P. Forti and Christian Wenter and Giorgio Basile and Anna Lasagni and A. Padovani and L. Rozzini and Maria Cottino and S. Vitali and G. Tripi and Stefano Avanzi and Giorgio Annoni and Giovanni Ruotolo and Federica Boschi and Paolo Bonino and Niccol{\`o} Marchionni and Sara Fascendini and Gabriele Noro and Renato Turco and Ubezio, {M. C.} and C. Serrati and Maria Infante and Simona Gentile and Pernigotti, {Luigi M.} and Biagini, {Carlo A.} and Enzo Canonico and Pietro Bonati and Pietro Gareri and Paolo Caffarra and Arcangelo Ceretti and Rosanna Castiglia and Carlo Gabelli and Storto, {Mario Lo} and P. Putzu and Santo, {Simona Di}",
year = "2016",
month = "7",
day = "18",
doi = "10.1186/s12916-016-0649-8",
language = "English",
volume = "14",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",

}

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, G.

AU - Morandi, A.

AU - Di Santo, Simona Gabriella

AU - Mazzone, Andrea

AU - Cherubini, Antonio

AU - Mossello, Enrico

AU - Bo, Mario

AU - Bianchetti, A.

AU - Rozzini, R.

AU - Zanetti, Ermellina

AU - Musicco, Massimo

AU - Ferrari, A.

AU - Ferrara, Nicola

AU - Trabucchi, M.

AU - Boffelli, S.

AU - Stefano, Fabio Di

AU - Filippi, Francesco De

AU - Guerini, F.

AU - Bertoletti, Erik

AU - March, Albert

AU - Margiotta, Alessandro

AU - Mecocci, Patrizia

AU - Addesi, Desireè

AU - Fantò, F.

AU - Dijik, Babette

AU - Porrino, Paola

AU - Cotroneo, A.

AU - Galli, Giovanni

AU - Bruni, Amalia Cecilia

AU - Bernardini, B.

AU - Corsini, C.

AU - Cagnin, Annachiara

AU - Zurlo, Amedeo

AU - Barbagallo, Giuseppe

AU - Lunardelli, Maria Lia

AU - Martini, E.

AU - Battaglia, Giuseppe

AU - Latella, Raffaele

AU - Petritola, Donatella

AU - Sinforiani, Elena

AU - Cester, A.

AU - Formilan, M.

AU - Carbone, Pasqualina

AU - Appollonio, I. M.

AU - Cereda, Diletta

AU - Tremolizzo, Lucio

AU - Bottacchi, E.

AU - Lucchetti, Lucio

AU - Mariani, Claudio

AU - Rapazzini, Piero

AU - Romanelli, Giuseppe

AU - Marengoni, A.

AU - Zuliani, Giovanni

AU - Bianchi, Lara

AU - Suardi, Teresa

AU - Muti, Ettore

AU - Bottura, Renato

AU - Sgrò, Giovanni

AU - Mandas, Antonella

AU - Serchisu, Luca

AU - Crippa, Patrizia

AU - Ivaldi, Claudio

AU - Ungar, Andrea

AU - Villani, Daniele

AU - Raimondi, Clara

AU - Mussi, Chiara

AU - Isaia, Giancarlo

AU - Provenzano, Giuseppe

AU - Mari, Daniela

AU - Odetti, P.

AU - Monacelli, Fiammetta

AU - Antonelli Incalzi, R.

AU - Pluderi, Alice

AU - Bellamoli, Claudio

AU - Terranova, Luciano

AU - Scarpini, Elio Angelo

AU - D'Amico, Ferdinando

AU - Cavallini, Maria Chiara

AU - Guerrini, Gianbattista

AU - Scotuzzi, AnnaMaria

AU - Chiarello, Antonino

AU - Pilotto, A.

AU - Tognini, Sara

AU - Dell'Aquila, Giuseppina

AU - Toigo, G.

AU - Ceschia, Giuliano

AU - Piccinini, Maristella

AU - Fabbo, A.

AU - Zoli, Marco

AU - Forti, P.

AU - Wenter, Christian

AU - Basile, Giorgio

AU - Lasagni, Anna

AU - Padovani, A.

AU - Rozzini, L.

AU - Cottino, Maria

AU - Vitali, S.

AU - Tripi, G.

AU - Avanzi, Stefano

AU - Annoni, Giorgio

AU - Ruotolo, Giovanni

AU - Boschi, Federica

AU - Bonino, Paolo

AU - Marchionni, Niccolò

AU - Fascendini, Sara

AU - Noro, Gabriele

AU - Turco, Renato

AU - Ubezio, M. C.

AU - Serrati, C.

AU - Infante, Maria

AU - Gentile, Simona

AU - Pernigotti, Luigi M.

AU - Biagini, Carlo A.

AU - Canonico, Enzo

AU - Bonati, Pietro

AU - Gareri, Pietro

AU - Caffarra, Paolo

AU - Ceretti, Arcangelo

AU - Castiglia, Rosanna

AU - Gabelli, Carlo

AU - Storto, Mario Lo

AU - Putzu, P.

AU - Santo, Simona Di

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

UR - http://www.scopus.com/inward/record.url?scp=84978827758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978827758&partnerID=8YFLogxK

U2 - 10.1186/s12916-016-0649-8

DO - 10.1186/s12916-016-0649-8

M3 - Article

VL - 14

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 106

ER -