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Latest & greatest articles for delirium
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Excited Delirium Syndrome and Sudden Death BestBets: Excited Delirium Syndrome and Sudden Death Excited Delirium Syndrome and Sudden Death Report By: Karl Huesgen, MD - Resident Physician Search checked by Bryan Judge MD - Faculty Physician Institution: Grand Rapids Medical Education Partners/Michigan State University, USA Date Submitted: 7th September 2012 Date Completed: 24th February 2014 Last Modified: 24th February 2014 Status: Green (complete) Three Part Question In [adult patients (...) ] presenting to the Emergency Department with suspected [excited delirium syndrome], what are the [clinical features associated with significant morbidity and mortality]? Clinical Scenario You are working a shift in an Emergency Department (ED), and you receive a call from prehospital providers requesting advice in management of a violent and incoherent patient with strength far in excess of expected for his size. This seems consistent with reports you have read of Excited Delirium Syndrome (EXDS). You
The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts. Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment.To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method.Validation analysis in 2 independent cohorts.Three academic medical centers.The first cohort included 300 patients aged (...) 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older.A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated.Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P
Delirium Severity in the Hospitalized Patient: Time to Pay Attention 24733202 2014 06 09 2018 12 02 1539-3704 160 8 2014 Apr 15 Annals of internal medicine Ann. Intern. Med. Delirium severity in the hospitalized patient: time to pay attention. 574-5 10.7326/M14-0553 Eubank Kathryn J KJ Covinsky Kenneth E KE eng K24 AG029812 AG NIA NIH HHS United States P30 AG044281 AG NIA NIH HHS United States K24AG029812 AG NIA NIH HHS United States P30AG044281 AG NIA NIH HHS United States Editorial Research (...) Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Comment United States Ann Intern Med 0372351 0003-4819 AIM IM Ann Intern Med. 2014 Apr 15;160(8):526-33 24733193 Delirium diagnosis Female Humans Male Psychological Tests 2014 4 16 6 0 2014 4 16 6 0 2014 6 10 6 0 ppublish 24733202 1860540 10.7326/M14-0553 PMC4112185 NIHMS602295 Ann Intern Med. 2014 Apr 15;160(8):526-33 24733193 Ann Intern Med. 1990 Dec 15;113(12):941-8 2240918 N Engl J Med. 2006 Mar 16;354(11):1157-65 16540616 Age Ageing
Delirium in adult patients receiving palliative care: a systematic review of the literature. Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed (...) the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies
Interventions for preventing delirium in older people in institutional long-term care. Delirium is a common and distressing complication of a range of stressor events including infection, new medications and environment change that is often experienced by older people with frailty and dementia. Older people living in institutional long-term care (LTC)are at high risk of delirium, which increases the risk of admission to hospital, development of or worsening of dementia, and mortality.Delirium (...) is also associated with substantial healthcare costs. Although it is possible to prevent delirium in the hospital setting by providing multicomponent delirium prevention interventions it is currently unclear whether interventions to prevent delirium in LTCare effective.To assess the effectiveness of interventions for preventing delirium in older people in long term care.We searched ALOIS (www.medicine.ox.ac.uk/alois) - the Cochrane Dementia and Cognitive Improvement Group's Specialised Register- on 23
Cornell Assessment of Pediatric Delirium: A Valid, Rapid, Observational Tool for Screening Delirium in the PICU To determine validity and reliability of the Cornell Assessment of Pediatric Delirium, a rapid observational screening tool.Double-blinded assessments were performed with the Cornell Assessment of Pediatric Delirium completed by nursing staff in the PICU. These ratings were compared with an assessment by consultation liaison child psychiatrist using the Diagnostic and Statistical (...) Manual IV criteria as the "gold standard" for diagnosis of delirium. An initial series of duplicate Cornell Assessment of Pediatric Delirium assessments were performed in blinded fashion to assess interrater reliability. Nurses recorded the time required to complete the Cornell Assessment of Pediatric Delirium screen.Twenty-bed general PICU in a major urban academic medical center over a 10-week period, March-May 2012.One hundred eleven patients stratified over ages ranging from 0 to 21 years
American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults American Geriatrics Society Clinical Practice Guidelines for Postoperative Delirium in Older Adults Logging In... × Welcome to GeriatricsCareOnline! AGS or ADGAP MEMBER Attention AGS Members! As an AGS Member, you already have an account automatically set up on GeriatricsCareOnline.org. Your username and password are the same that you use to log onto MyAGS. (If you do not remember your MyAGS (...) credentials, ). Please do not register for a new user account if you are an AGS member - if you create a new account, you will not be recognized as a member in the system. Username Password remember Remember me Login NON-AGS MEMBER Username Password Remember me Login Search: Toggle navigation Search: Guideline for Postoperative Delirium in Older Adults PRODUCT DETAILS × PIN Subscriprion Validating... Product Titile : American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium
Development and validation of a delirium predictive score in older people delirium is frequently under diagnosed in older hospitalised patients. Predictive models have not been widely incorporated in clinical practice.to develop and validate a predictive score for incident delirium.two consecutive observational prospective cohorts (development and validation) in a university affiliated hospital.inpatients 65 years and older.in the development cohort patients were assessed within the first 48 h (...) of admission, and every 48 h thereafter, using the confusion assessment method to diagnose delirium and data were collected on comorbidity, illness severity, functional status and laboratory. Delirium predictive score (DPS) was constructed in the development cohort using variables associated with incident delirium in the multivariate analysis (P < 0.05), and then tested in a validation cohort of comparable patients, admitted without delirium. Receiver operating characteristic (ROC) analysis and likelihood
Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method Delirium is a common form of acute brain dysfunction with prognostic significance. Health care professionals caring for older emergency department (ED) patients miss delirium in approximately 75% of cases. This error results from a lack of available measures that can be performed rapidly enough to be incorporated into clinical practice (...) . Therefore, we developed and evaluated a novel 2-step approach to delirium surveillance for the ED.This prospective observational study was conducted at an academic ED in patients aged 65 years or older. A research assistant and physician performed the Delirium Triage Screen (DTS), designed to be a highly sensitive rule-out test, and the Brief Confusion Assessment Method (bCAM), designed to be a highly specific rule-in test for delirium. The reference standard for delirium was a comprehensive
An early prediction of delirium in the acute phase after stroke We developed and validated a risk score to predict delirium after stroke which was derived from our prospective cohort study where several risk factors were identified.Using the β coefficients from the logistic regression model, we allocated a score to values of the risk factors. In the first model, stroke severity, stroke subtype, infection, stroke localisation, pre-existent cognitive decline and age were included. The second (...) %). The second had an AUC of 0.83 (sensitivity 76%, specificity 81%). The third model gave an AUC of 0.82 (sensitivity of 73%, specificity 75%). We conclude that model 2 is easy to use in clinical practice and slightly better than model 3 and, therefore, was used to create risk tables to use as a tool in clinical practice.A model including age, stroke severity, stroke subtype and infection can be used to identify patients who have a high risk to develop delirium in the early phase of stroke.
Delirium in elderly people. Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows (...) that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology--it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding
Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds in Hospitalized Older Adults with Hip Fracture To determine whether a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery.Ancillary study to a randomized clinical trial.Thirteen hospitals in the United States and Canada.One hundred thirty-nine individuals hospitalized with hip fracture aged 50 and older (mean age 81.5 ± 9.1) with cardiovascular (...) if they developed symptoms of anemia or their hemoglobin fell below 8 g/dL.Delirium assessments were performed before randomization and up to three times after randomization. The primary outcome was severity of delirium according to the Memorial Delirium Assessment Scale (MDAS). The secondary outcome was the presence or absence of delirium defined according to the Confusion Assessment Method (CAM).The liberal group received a median two units of blood and the restrictive group zero units of blood. Hemoglobin
On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98 PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
In-facility delirium prevention programs as a patient safety strategy: a systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Delirium in older patients: a diagnostic study of NEECHAM Confusion Scale in surgical intensive care unit To estimate the diagnostic value and determine the feasibility of the NEECHAM Confusion Scale on critically ill older patients.Delirium is a common syndrome in hospitalised older patients, especially in surgical intensive care units, and the consequences of under-detection can be very serious for older people. Therefore, assessment of the cognitive status of older patients using a valid (...) instrument is important in intensive care units.A descriptive prospective design was used.Consecutive nonintubated patients aged 65 and older, admitted to a surgical intensive care unit of an Italian hospital during a seven months period, were assessed for delirium using the NEECHAM scale and the Confusion Assessment Method for intensive care unit, once per shift, for 48 hours after admission. Cohen's kappa coefficient, ROC curve, sensitivity and specificity were estimated. An open ended questionnaire
Tools to detect delirium superimposed on dementia: a systematic review To identify valid tools to diagnose delirium superimposed on dementia.Systematic review of studies of delirium tools that explicitly included individuals with dementia.Hospital.Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments.PubMed, Embase, and Web of Science databases were (...) searched for articles in English published between January 1960 and January 2012.Nine studies fulfilled the selection criteria. Of 1,569 participants, 401 had dementia, and 50 had delirium superimposed on dementia. Six delirium tools were evaluated. One study using the Confusion Assessment Method (CAM) with 85% of participants with dementia had high specificity (96-100%) and moderate sensitivity (77%). Two intensive care unit studies that used the CAM for the Intensive Care Unit (CAM-ICU) reported 100
Clinical Practice Guideline for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit Clinical Practice Guidelines for the Management of Pain, Agi... : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me on this computer Register (...) Manager Save my selection doi: 10.1097/CCM.0b013e3182783b72 Special Article Free Objective: To revise the “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult” published in Critical Care Medicine in 2002. Methods: The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain , agitation and sedation , delirium management, and associated outcomes
Cost-effectiveness of multi-component interventions to prevent delirium in older people admitted to medical wards Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.