Delirium Risk Prediction, Healthcare Use and Mortality of Elderly Adults in the Emergency Department
Open accessAbstract
Objectives: To create a risk prediction rule for delirium in elderly adults in the emergency department ( ED ) and to compare mortality and resource use of elderly adults in the ED with and without delirium. Design: Prospective observational study. Setting: Urban tertiary care ED . Participants: Individuals aged 65 and older presenting for ED care ( N = 700). Measurements: A trained research assistant performed a structured mental status assessment and attention tests, after which delirium was determined using the C onfusion A ssessment M ethod. Data were collected on participant demographics, comorbidities, medications, ED course, hospital and intensive care unit ( ICU ) admission, length of stay, hospital charges, 30‐day rehospitalization, and mortality. Results: Nine percent of elderly study participants had delirium. Using logistic regression, a delirium prediction rule consisting of older age, prior stroke or transient ischemic attack, dementia, suspected infection, and acute intracranial hemorrhage was created had good predictive accuracy (area under the receiver operating characteristic curve = 0.77). Admitted participants with ED delirium had longer median lengths of stay (4 vs 2 days) and were more likely to require ICU admission (13% vs 6%) and to be discharged to a new long‐term care facility (37% vs 9%) than those without. In all participants, ED delirium was associated with higher 30‐day mortality (6% vs 1%) and 30‐day readmission (27% vs 13%). Conclusion: This risk prediction rule may help identify a group of individuals in the ED at high risk of developing delirium who should undergo screening, but it requires external validation. Identification of delirium in the ED may enable physicians to implement strategies to decrease delirium duration and avoid inappropriate discharge of individuals with acute delirium, improving outcomes.
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Cites
Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-12-941 · Cited by 5,250 · see citing works
Inouye, S. K. (2006) · New England Journal of Medicine · doi:10.1056/nejmra052321 · Cited by 2,091 · see citing works
Precipitating Factors for Delirium in Hospitalized Elderly Persons
Inouye, S. K. (1996) · JAMA · doi:10.1001/jama.1996.03530350034031 · Cited by 1,430 · see citing works
One-Year Health Care Costs Associated With Delirium in the Elderly Population
LESLIE, D. L. (2008) · Archives of Internal Medicine · doi:10.1001/archinternmed.2007.4 · Cited by 1,038 · see citing works
A Prospective Study of Delirium in Hospitalized Elderly
Francis, J. (1990) · JAMA · doi:10.1001/jama.1990.03440080075027 · Cited by 900 · see citing works
A Clinical Prediction Rule for Delirium After Elective Noncardiac Surgery
Marcantonio, E. R. (1994) · JAMA · doi:10.1001/jama.1994.03510260066030 · Cited by 894 · see citing works
Self-citationInouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D., & Tinetti, M. E. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00005 · Cited by 854 · see citing works
The Confusion Assessment Method: A Systematic Review of Current Usage
Wei, L. A., Fearing, M. A., Sternberg, E. J., & Inouye, S. K. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01674.x · Cited by 796 · see citing works
Does delirium contribute to poor hospital outcomes?
Inouye, S. K., Rushing, J. T., Foreman, M. D., Palmer, R. M., & Pompei, P. (1998) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1998.00073.x · Cited by 695 · see citing works
The Relationship of Postoperative Delirium With Psychoactive Medications
Marcantonio, E. R. (1994) · JAMA · doi:10.1001/jama.1994.03520190064036 · Cited by 565 · see citing works
Self-citationThe Prognostic Significance of Delirium in Older Hospital Patients
O’Keeffe, S. T., & Lavan, J. N. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb04503.x · Cited by 475 · see citing works
Risk Factors for Delirium in Hospitalized Elderly
Schor, J. D. (1992) · JAMA · doi:10.1001/jama.1992.03480060073033 · Cited by 471 · see citing works
Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes
Han, J. H., Zimmerman, E. E., Cutler, N. S., Schnelle, J. F., Morandi, A., Dittus, R. S., Storrow, A. B., & Ely, E. W. (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00339.x · Cited by 435 · see citing works
Prevalence and detection of delirium in elderly emergency department patients.
Élie, M., Rousseau, F., Cole, M. G., Primeau, F., McCusker, J., & Bellavance, F. (2000) · Europe PMC (PubMed Central) · Cited by 345 · see citing works
The prevalence and documentation of impaired mental status in elderly emergency department patients
Hustey, F. M., & Meldon, S. W. (2002) · Annals of Emergency Medicine · doi:10.1067/mem.2002.122057 · Cited by 337 · see citing works
Delirium in Older Emergency Department Patients Discharged Home: Effect on Survival
Kakuma, R., du Fort, G. G., Arsenault, L., et al. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51151.x · Cited by 336 · see citing works
Han, J. H., Wilson, A., Vasilevskis, E. E., Shintani, A., Schnelle, J. F., Dittus, R. S., Graves, A. J., Storrow, A. B., Shuster, J. L., & Ely, E. W. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.05.003 · Cited by 329 · see citing works
Kalisvaart, K. J., Vreeswijk, R., de Jonghe, J. F. M., et al. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00704.x · Cited by 268 · see citing works
Prognosis of delirium in elderly hospital patients.
Cole, M. G., & Primeau, F. J. (1993) · PubMed · Cited by 259 · see citing works
Delirium in the Emergency Department: An Independent Predictor of Death Within 6 Months
Han, J. H., Shintani, A., Eden, S., et al. (2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.03.003 · Cited by 254 · see citing works
Unrecognized delirium in ED geriatric patients
Lewis, L. M., Miller, D. K., Morley, J. E., et al. (1995) · The American Journal of Emergency Medicine · doi:10.1016/0735-6757(95)90080-2 · Cited by 245 · see citing works
The effect of mental status screening on the care of elderly emergency department patients
Hustey, F. M., Meldon, S. W., SMITH, M. D., et al. (2003) · Annals of Emergency Medicine · doi:10.1067/mem.2003.152 · Cited by 224 · see citing works
Quality Indicators for Geriatric Emergency Care
Terrell, K. M., Hustey, F. M., Hwang, U., Gerson, L. W., Wenger, N. S., Miller, D. K., & on behalf of the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2009.00382.x · Cited by 186 · see citing works
Predicting Delirium After Vascular Surgery
Böhner, H., Hummel, T. C., Habel, U., Miller, C., Reinbott, S., Yang, Q., Gabriel, A., Friedrichs, R., Müller, E. E., Ohmann, C., et al. (2003) · Annals of Surgery · doi:10.1097/01.sla.0000077920.38307.5f · Cited by 163 · see citing works
Delirium and Other Cognitive Impairment in Older Adults in an Emergency Department
Naughton, B. J., Moran, M. B., Kadah, H., Heman‐Ackah, Y. D., & Longano, J. (1995) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(95)70202-4 · Cited by 160 · see citing works
Monette, J., du Fort, G. G., Fung, S., Massoud, F., Moride, Y., Arsenault, L., & Afilalo, M. (2001) · General Hospital Psychiatry · doi:10.1016/s0163-8343(00)00116-x · Cited by 114 · see citing works
Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review
Carin-Levy, G., Mead, G. E., Nicol, K., Rush, R., & van Wijck, F. (2012) · Journal of Neurology · doi:10.1007/s00415-011-6383-4 · Cited by 107 · see citing works
Marcantonio, E. R. (2011) · Annals of Internal Medicine · doi:10.7326/0003-4819-154-11-201106070-01006 · Cited by 102 · see citing works
Self-citationPredicting Delirium in Elderly Patients: Development and Validation of a Risk-stratification Model
O’Keeffe, S. T., & Lavan, J. N. (1996) · Age and Ageing · doi:10.1093/ageing/25.4.317 · Cited by 101 · see citing works
Prevalence and Risk Factors for Postoperative Delirium in a Cardiovascular Intensive Care Unit
Chang, Y., Tsai, Y., Lin, P.-J., Chen, M., & Liu, C.-Y. (2008) · American Journal of Critical Care · doi:10.4037/ajcc2008.17.6.567 · Cited by 99 · see citing works
Han, J. H., Bryce, S., Ely, E. W., Kripalani, S. B., Morandi, A., Shintani, A., Jackson, J. C., Storrow, A. B., Dittus, R. S., & Schnelle, J. F. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.12.002 · Cited by 92 · see citing works
Risk factors for delirium after major trauma
Angles, E. M., Robinson, T. N., Biffl, W. L., Johnson, J. J., Moss, M., Tran, Z. V., & Moore, E. E. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2008.07.037 · Cited by 65 · see citing works
Simon, S. E., Bergmann, M. A., Jones, R. N., et al. (2006) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2006.02.006 · Cited by 65 · see citing works
Delirium in the Nursing Home Patients Seen in the Emergency Department
Han, J. H., Morandi, A., Ely, E. W., Callison, C., Zhou, C., Storrow, A. B., Dittus, R. S., Habermann, R., & Schnelle, J. F. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02219.x · Cited by 63 · see citing works
Delirium Following Acute Myocardial Infarction: Incidence, Clinical Profiles, and Predictors
Uğuz, F., Kayrak, M., Çíçek, E., et al. (2010) · Perspectives In Psychiatric Care · doi:10.1111/j.1744-6163.2010.00249.x · Cited by 40 · see citing works
Selecting optimal screening items for delirium: an application of item response theory
Yang, F. M., Jones, R. N., Inouye, S. K., et al. (2013) · BMC Medical Research Methodology · doi:10.1186/1471-2288-13-8 · Cited by 17 · see citing works
Delirium in the acute phase after stroke: Incidence, risk factors, and outcome
Oldenbeuving, A. W., de Kort, P. L. M., Jansen, B. P. W., Algra, A., Kappelle, L. J., & Roks, G. (2011) · Neurology · doi:10.1212/wnl.0b013e318210411f · Cited by 4 · see citing works
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The interface between delirium and dementia in elderly adults
Fong, T. G., Davis, D., Growdon, M. E., Albuquerque, A., & Inouye, S. K. (2015) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00101-5 · Cited by 595 · see citing works
Yang, Z., Xu, X., Yao, B., Rogers, E., Zhang, S., Intille, S., Shara, N., Gao, G. G., & Wang, D. (2024) · Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies · doi:10.1145/3659625 · Cited by 120 · see citing works
“For healthcare professionals, researchers have also leveraged LLMs to support public health interventions [58], clinical pre-screening [48, 115], risk prediction [16, 42, 63, 86] and information processing [9, 10, 26, 64, 84, 85].”
Background
- Authors
- Kennedy, M., Enander, R. A., Tadiri, S. P., Wolfe, R. E., Shapiro, N. I., & Marcantonio, E. R.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Kennedy, Maura
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2014-02-10
- Volume
- 62
- Issue
- 3
- Pages
- 462-469
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3959285
- OpenAlex
- W1967487362
- Cited by
- 205
- References
- 37
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 21 · 2023: 24 · 2022: 21 · 2021: 25 · 2020: 27 · 2019: 19 · 2018: 14 · 2017: 12 · 2016: 15 · 2015: 8 · 2014: 3
- FWCI
- 10.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Aging GEMSSTAR (1R03AG040706-01)
- John A. Hartford Foundation, Inc
- Emergency Medicine Foundation
- Society for Academic Emergency Medicine
- National Institute on Aging (K24 AG035075)
- National Institutes of Health (HL091757, GM076659, 5R01HL093234-02)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- delirium, older adults, emergency department, Confusion Assessment Method, 30-day mortality, hospital resource utilization, intensive care unit admission, length of hospital stay, 30-day readmission, stroke, dementia, infection, intracranial hemorrhage, delirium screening, long-term care discharge
- MeSH terms
- Aged, Aged, 80 and over, Delirium, Delivery of Health Care, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Length of Stay, Male, Massachusetts, Mental Status Schedule, Prospective Studies, Risk Factors, Geriatric Assessment, Incidence, Survival Rate, Stroke
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