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Hyperactive delirium during emergency department stay: analysis of risk factors and association with short-term outcomes

2023; Springer Science+Business Media; Volume: 19; Issue: 2 Linguagem: Inglês

10.1007/s11739-023-03440-3

1970-9366

Òscar Miró, Gina Osorio, Aitor Alquézar‐Arbé, Sira Aguiló, Cesáreo Fernández, Guillermo Burillo, Javier Jacob, Pere Llorens, Lluís Llauger, Ángel Peláez González, Edmundo Ramón Figuera Castro, Ricardo Juarez González, María José Blanco Hoffman, Fátima Fernández Salgado, Teresa Pablos Pizarro, María Amparo Berenguer Diez, Marina Truyol Más, Nieves López-Laguna, Jacinto García Acosta, Carmen Fernández Domato, Francisco Javier Diego Robledo, Patxi Ezponda, Andrea Martínez Lorenzo, Juan Vicente Ortega Liarte, Inmaculada García Rupérez, Setefilla Borne Jerez, Claudia Corugedo Ovies, Blanca Andrea Gallardo Sánchez, Juan González del Castillo, Juan González del Castillo, Cesáreo Fernández Alonso, Jorge García- Lamberechts, Ana Chacón García, Paula Queizán García, Andrea Peirago Bravo, Alejandro Melcon Villalibre, Sara Vargas Lobé, Cristina Güemes de la Iglesia, Beatriz Honrado Galán, Sandra Moreno Ruíz, Osvaldo Jorge Troiano Ungerer, Enrique Martín Mojarro, Guillermo Burillo–Putze, Aarati Vaswani- Bulchand, Patricia Eiroa Hernández, Patricia Parra Esquivel, Pascual Piñera, Inés García Rosa, María Consuelo Quesada Martínez, Marta Isabel Gómez Gómez, Yurena Reverte Pagán, Patricia Gantes Nieto, V.A. Sevilla Linares, Sara González, Sònia Jiménez, Sira Aguiló Mir, Francesc Xavier Alemany González, María Florencia Poblete Palacios, Claudia Lorena Amarilla Molinas, Gina Osorio, Sandra Cuerpo Cardeñosa, Matilde González Tejera, Ana Puche Alcaraz, Cristina Chacón García, Leticia Serrano Lázaro, Javier Millán Soria, Jésica Mansilla Collado, María Bóveda García, Pere Llorens Soriano, Adriana Gil Rodrigo, Begoña Espinosa Fernández, Mónica Veguillas Benito, Sergio Guzmán Martínez, Gema Jara Torres, María Caballero Martínez, Javier Jacob, Ferrán Llopis, Elena Fuentes, Lidia Fuentes, Francisco Chamorro, Lara Guillén, Nieves López, Coral Suero Méndez, Lucía Zambrano Serrano, R. Martos, Manuel Salido Mota, Valle Toro Gallardo, Antonio Real López, Lucía Ocaña Martínez, Esther Muñoz Soler, Mario Lozano Sánchez, E Blesa, Fahd Beddar Chaib, Rodrigo Javier Gil Hernández, Jorge Pedraza García, Paula Pedraza Ramírez, Francisco Javier Montero‐Pérez, Carmen Lucena Aguilera, Francisco de Borja Quero Espinosa, Ángela Cobos Requena, Esperanza Muñoz Triano, Inmaculada Bajo Fernández, María Calderón, Sierra Bretones Baena, Iria Miguéns Blanco, I. Muñoz Betegón, Dariela Edith Micheloud Giménez, Jorge Sánchez-Tembleque Sánchez, Belén Macías Bou, Paloma Díez Romero, Maria Cardona, Leonor Andrés Berián, Lucía González Ferreira, R. González, María Eugenia Rodríguez Palma, Javier Varona Castrillo, Daniel R. Pérez, Alberto Álvarez Madrigal, Marta Iglesias Vela, Mónica Santos Orús, Rudiger Carlos Chávez Flores, Miguel Moreno Martín, Albert Carbó Jordá, Enrique González Revuelta, Sara Sánchez Aroca, Rafael Antonio Pérez-Costa, María Rodríguez Romero, Esperanza Marín Arranz, Elena Ramírez Gallardo, A. Bataller, Paula Sánchez Herrero, Julia Martínez-Ibarreta Zorita, Irene Cabrera Rodrigo, Beatriz Mañero Criado, Raquel Torres Gárate, Rebeca González González, Eva Quero Motto, Nuria Tomas García, Laura Bernal Martínez, Marina Carrión Fernández, Carmen Escudero Sánchez, Belén Morales Franco, María Adroher Múñoz, Ester Soy Ferrer, E Ferrer, Jeong-Uh Hong Cho, Patricia Trent Español, Fernándo López López, Jorge Navarro Calzada, Belén Gros Bañeres, Cristina Martín Durán, María Teresa Escolar Martínez-Berganza, Iciar González Salvatierra, Sara Gayoso Martín, María Goretti Sánchez Sindín, María Esther Fernández Álvarez, Martina Silva Penas, Margarita Puiggali Ballard, María Carmen Petrus Rivas, Bárbara Gómez Gómez, Isabel Cirera Lorenzo, Aitor Alquézar Arbé, Isel Borrego Yanes, Adriana Laura Doi Grande, Sergio Herrera, Olga Gutiérrez, P. Ponte, Carlos Romero Carrete, Sayoa Francesena González, Celia Rodríguez Valles, Verónica Vázquez Rey, Antonio Rodríguez Mejía, Elena Carrasco Fernández, Mónica Cañete, Mar Sousa, Laura Molina, Esther Ruescas, P. Asensio, María Martínez Juan, Beatriz Paderne Díaz, Eva de las Nieves Rodríguez, Gema Gómez García, Amparo Fernández-Simón Almela, Esther Pérez García, Pedro Rivas Del Valle, María Sánchez Moreno, Rafaela Ríos Gallardo, Laura Redondo Lora, Ana Gómez Caminero, Claudio Bueno Mariscal, María Amparo Berenguer Diez, María Ángeles de Juan Gómez, María Luisa López Grima, Rigoberto Jesús del Rio Navarro, Pere Rull Bertrán, Marta Masid Barcon, Fiorella Granado Fronzo, Núria Perelló Viola, Lourdes Hernández-Castells, José Noceda, María Teresa Sánchez Moreno, Raquel Benavent Campos, Alejandro Cortés Soler, María Teresa Maza Vera, Raquel Rodríguez Calveiro, Paz Balado Dacosta, Violeta Delgado Sardina, Emma González Nespereira, Elena Sánchez Fernández-Linares, Àngel García García, Manuel Ángel Palomero Martín, Jesús Ángel Sánchez Serrano, María Jesús Soriano Pérez, José Ramón Oliva Ramos, Virginia Carbajosa Rodríguez, Susana Sánchez Ramón, M. Marchena, José María Santos Martín, Jesús Santianes Patiño, Octavio Gutiérrez Alcalá, Pablo Herrero, Alba Martínez Alonso, Ángela López Carrillo, Belén Pérez Fernández, Carmen Pérez Fonseca,

Healthcare Decision-Making and Restraints

Abstract To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24–4.82), transfer to the ED observation unit (1.62, 1.23–2.15), chronic treatment with opiates (1.51, 1.09–2.09) and length of ED stay longer than 12 h (1.41, 1.02–1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37–0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83–2.78), need for hospitalization 25.6% and 25% (1.09, 0.83–1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24–4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80–2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82–2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.