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Evaluation of Patients with Delirium in the Emergency Department

Year 2012, Volume: 2012 Issue: 4, 381 - 385, 01.04.2012
https://doi.org/10.5152/balkanmedj.2012.023

Abstract

Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing. Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium. Turkish Başlık: Acil Serviste Deliryumlu Hastaların Değerlendirilmesi Anahtar Kelimeler: Acil Servis, Deliryum, Etyoloji,Yaş grupları Amaç: Deliryum, akut olarak başlayan ve dalgalı bir seyir gösteren global mental durum değişikliği ile karakterize nöropsikiyatrik bir sendromdur. Herhangi bir hastalık nedeni ile hastanede yatırılan hastalar arasında ki deliryum sıklığının % 2 ile 30 arasında olduğu bildirilmiştir. Bununla birlikte, literatürde 65 yaş ve üzeri yatan hastalarda deliryum sıkılığını değerlendiren sadece birkaç çalışma vardır. Bizim bilgilerimize göre bu çalışma, acil serviste deliriyumlu erişkin hastalarda tüm yaş gruplarını içeren ilk çalışmadır. Bu çalışmada, deliryumun etyolojik nedenlerine göre sınıflandırılması, yaş gruplarının etiyolojik nedenler ve sıklık açısından karşılaştırılması amaçlandı. Materyal Metod: Aralık 2002-2003 tarihleri arasında, Mental Bozuklukların Tanısal ve Sayımsal El kitabı – IV (DSM-IV) kriterlerine göre acil serviste deliryum tanısı alan 43 hasta çalışmaya dâhil edildi. Hastalar iki gruba ayrıldı (Grup I: yaş >65yıl ve Grup II: yaş ≤65yıl). Detaylı bir anamnezi takiben, her hastanın fizik ve nörolojik muayenesi yapıldı. Buna ek olarak Mini Mental Durum Değerlendirme Skalası uygulandı. Endikasyonu olan tüm hastalara radyolojik ve hematolojik incelemeler yapıldı. Bulgular: Deliryumlu hastaların 18 kadın ve 25 erkekti. Ortalama yaş 61.18 ±18 idi. 43 hastanın 21 tanesi Grup I'de, 22 tanesi Grup II'de idi. Deliryumun en sık nedeni metabolik bozuklukları idi. Grup I ve Grup II arasında deliryumun etyolojik faktörleri veya sıklığı açısından fark yoktu. Sonuç: Acil servislerde deliryumlu hastalar etyolojik faktörler ve özellikle de metabolik bozukluklar açısından değerlendirilmelidir. Çünkü deliryum için altta yatan sebebin tedavisi esastır.

References

  • Ashla MFM. Delirium. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, (eds.), Neurology in clinical practice, Boston; But- terworth – Heinemann, 2000.pp.25-36.
  • Bronwn TM, Boyle MF. ABC of psychological medicine: Delirium. BMJ 2002;325:644-7. [CrossRef]
  • David JM. Delirium: optimising management. BMJ 2001;322:144-9. [CrossRef]
  • Inouye SK. The Dilemma of delirium: Clinical and research con- troversies regarding diagnosis and evaluation of delirium in hos- pitalized elderly medical patients. Am J Med 1994;97:278-88. [CrossRef]
  • Wahlun L, Björlin GA. Delirium in clinic practice: experiences from a specialized delirium word. Demend Geriatr Cogn Disord 1999;10:389-92. [CrossRef]
  • O’Keefe S, Lavan J. The prognostic significance of delirium in older hospital patients. J Am GS 1997;45:174-8.
  • Elie M, Rousseau F, Cole M, Primeau F, Cusker JM, Bellavance F. Prevalance and detection of delirium emergency depertment patients. CMAJ 2000;163:977-81.
  • American Psychiatric Association. Diagnostic and Statistical Man- ual of Mental Disorders.(DSM-IV-TR), 4th edn. Washington, DC: American Psychiatric Association, 2000.
  • Huff JS. Alterd mental status and coma. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds.), Emergency medicine: A comprehen- sive study guide. New york; Mc Graw-Hill, 2000.pp.1440-3.
  • Naughton BJ, Moran MB, Kadah H, Heman-Ackah Y, Longano J. Delirium and other cognitive impairment in older adults in an emer- gency department. Ann Emerg Med 1995;25:751-5. [CrossRef]
  • Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC. Unrec- ognized delirium in ED geriatric patients. Am J Emerg Med 1995;13:142-5. [CrossRef]
  • Wofford J, Loehr L, Schwartz E. Acute cognitive impairment in elderly ED patients: etiologies and outcomes. Am J Emerg Med 1996;14:649-53. [CrossRef]
  • Lipowski ZJ. Delirium acute confusional states. Toronto Universty press; Toronto, 1989.
  • Jacobson SA. Delirium in the elderly. Psychiatr Clin N Am 1997;20:91-110. [CrossRef]
  • Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Early recognition of delirium: review of the literature. J Clin Nurs 2001;10:721-9. [CrossRef]
  • Ferro JM, Caeiro L, Verdelho A. Delirium in acute stroke. Curr Opin Neurol 2002;15:51-5.
  • Trzepact PT. Delirium: Advances in diagnosis, pathophysiology, and treatment. Psychiatr Clin North Am1996;19:429-48.
  • Schor JD, Levkoff SE, Lipsitz LA, Reilly CH, Cleary PD, Rowe JW, et al. Risk factors for delirium in hospitalized elderly. JAMA 1992;267:827-31. [CrossRef]
  • Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097-101. [CrossRef]
  • Bullock R. The clinical benefits of rivastigmin may reflect its dual inhibitory mode of action–ahypothesis. In: J Clin Pract 2002;56:206-14.

Evaluation of Patients with Delirium in the Emergency Department

Year 2012, Volume: 2012 Issue: 4, 381 - 385, 01.04.2012
https://doi.org/10.5152/balkanmedj.2012.023

Abstract

References

  • Ashla MFM. Delirium. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, (eds.), Neurology in clinical practice, Boston; But- terworth – Heinemann, 2000.pp.25-36.
  • Bronwn TM, Boyle MF. ABC of psychological medicine: Delirium. BMJ 2002;325:644-7. [CrossRef]
  • David JM. Delirium: optimising management. BMJ 2001;322:144-9. [CrossRef]
  • Inouye SK. The Dilemma of delirium: Clinical and research con- troversies regarding diagnosis and evaluation of delirium in hos- pitalized elderly medical patients. Am J Med 1994;97:278-88. [CrossRef]
  • Wahlun L, Björlin GA. Delirium in clinic practice: experiences from a specialized delirium word. Demend Geriatr Cogn Disord 1999;10:389-92. [CrossRef]
  • O’Keefe S, Lavan J. The prognostic significance of delirium in older hospital patients. J Am GS 1997;45:174-8.
  • Elie M, Rousseau F, Cole M, Primeau F, Cusker JM, Bellavance F. Prevalance and detection of delirium emergency depertment patients. CMAJ 2000;163:977-81.
  • American Psychiatric Association. Diagnostic and Statistical Man- ual of Mental Disorders.(DSM-IV-TR), 4th edn. Washington, DC: American Psychiatric Association, 2000.
  • Huff JS. Alterd mental status and coma. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds.), Emergency medicine: A comprehen- sive study guide. New york; Mc Graw-Hill, 2000.pp.1440-3.
  • Naughton BJ, Moran MB, Kadah H, Heman-Ackah Y, Longano J. Delirium and other cognitive impairment in older adults in an emer- gency department. Ann Emerg Med 1995;25:751-5. [CrossRef]
  • Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC. Unrec- ognized delirium in ED geriatric patients. Am J Emerg Med 1995;13:142-5. [CrossRef]
  • Wofford J, Loehr L, Schwartz E. Acute cognitive impairment in elderly ED patients: etiologies and outcomes. Am J Emerg Med 1996;14:649-53. [CrossRef]
  • Lipowski ZJ. Delirium acute confusional states. Toronto Universty press; Toronto, 1989.
  • Jacobson SA. Delirium in the elderly. Psychiatr Clin N Am 1997;20:91-110. [CrossRef]
  • Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Early recognition of delirium: review of the literature. J Clin Nurs 2001;10:721-9. [CrossRef]
  • Ferro JM, Caeiro L, Verdelho A. Delirium in acute stroke. Curr Opin Neurol 2002;15:51-5.
  • Trzepact PT. Delirium: Advances in diagnosis, pathophysiology, and treatment. Psychiatr Clin North Am1996;19:429-48.
  • Schor JD, Levkoff SE, Lipsitz LA, Reilly CH, Cleary PD, Rowe JW, et al. Risk factors for delirium in hospitalized elderly. JAMA 1992;267:827-31. [CrossRef]
  • Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097-101. [CrossRef]
  • Bullock R. The clinical benefits of rivastigmin may reflect its dual inhibitory mode of action–ahypothesis. In: J Clin Pract 2002;56:206-14.
There are 20 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Latif Duran This is me

Dursun Aygün This is me

Publication Date April 1, 2012
Published in Issue Year 2012 Volume: 2012 Issue: 4

Cite

APA Duran, L., & Aygün, D. (2012). Evaluation of Patients with Delirium in the Emergency Department. Balkan Medical Journal, 2012(4), 381-385. https://doi.org/10.5152/balkanmedj.2012.023
AMA Duran L, Aygün D. Evaluation of Patients with Delirium in the Emergency Department. Balkan Medical Journal. April 2012;2012(4):381-385. doi:10.5152/balkanmedj.2012.023
Chicago Duran, Latif, and Dursun Aygün. “Evaluation of Patients With Delirium in the Emergency Department”. Balkan Medical Journal 2012, no. 4 (April 2012): 381-85. https://doi.org/10.5152/balkanmedj.2012.023.
EndNote Duran L, Aygün D (April 1, 2012) Evaluation of Patients with Delirium in the Emergency Department. Balkan Medical Journal 2012 4 381–385.
IEEE L. Duran and D. Aygün, “Evaluation of Patients with Delirium in the Emergency Department”, Balkan Medical Journal, vol. 2012, no. 4, pp. 381–385, 2012, doi: 10.5152/balkanmedj.2012.023.
ISNAD Duran, Latif - Aygün, Dursun. “Evaluation of Patients With Delirium in the Emergency Department”. Balkan Medical Journal 2012/4 (April 2012), 381-385. https://doi.org/10.5152/balkanmedj.2012.023.
JAMA Duran L, Aygün D. Evaluation of Patients with Delirium in the Emergency Department. Balkan Medical Journal. 2012;2012:381–385.
MLA Duran, Latif and Dursun Aygün. “Evaluation of Patients With Delirium in the Emergency Department”. Balkan Medical Journal, vol. 2012, no. 4, 2012, pp. 381-5, doi:10.5152/balkanmedj.2012.023.
Vancouver Duran L, Aygün D. Evaluation of Patients with Delirium in the Emergency Department. Balkan Medical Journal. 2012;2012(4):381-5.