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Latest & greatest articles for delirium
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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
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
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.
The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies 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 People Australian and New Zealand Society for Geriatric Medicine Position Statement 13 Delirium in Older People Revised 2012 1. Delirium is a syndrome characterized by the rapid onset of impaired attention that fluctuates, together with impaired cognition and / or altered consciousness, perceptual disturbances and behaviour. It may be the only sign of serious medical illness in an older person and should be urgently assessed. Misdiagnosis of delirium may have dire consequences (...) . 2. Better prevention and treatment is needed to avoid the poor outcomes that result from delirium, especially increased rates of cognitive and functional decline, prolonged hospital stay, institutionalisation and mortality. 3. All older persons should be assessed for risk factors for delirium on admission to hospital. These include dementia, polypharmacy, visual and hearing impairment, dehydration, functional disability, alcohol abuse, depression and advanced age. Many precipitating factors
Drug therapy for delirium in terminally ill adult patients. Delirium is a syndrome characterised by a disturbance of consciousness (often fluctuating), cognition and perception. In terminally ill patients it is one of the most common causes of admission to clinical care. Delirium may arise from any number of causes and treatment should be directed at addressing these causes rather than the symptom cluster. In cases where this is not possible, or treatment does not prove successful, the use (...) of drug therapy to manage the symptoms may become necessary. This is an update of the review published on 'Drug therapy for delirium in terminally ill adult patients' in The Cochrane Library 2004, Issue 2 ( Jackson 2004).To evaluate the effectiveness of drug therapies to treat delirium in adult patients in the terminal phase of a disease.We searched the following sources: CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE (1966 to 2012), EMBASE (1980 to 2012), CINAHL (1982 to 2012) and PSYCINFO
Cognitive trajectories after postoperative delirium. Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery.We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative (...) day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini-Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type.The 103 participants (46%) in whom delirium developed
Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD).To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD.Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry.Community-based (...) .771 persons aged 65 years or older with a clinical diagnosis of AD.Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs).Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did
Preventing delirium in an acute hospital using a non-pharmacological intervention delirium is a clinical syndrome associated with multiple short and long-term complications and therefore prevention is an essential part of its management. This study was designed to assess the efficacy of multicomponent intervention in delirium prevention.a total of 287 hospitalised patients at intermediate or high risk of developing delirium were randomised to receive a non-pharmacological intervention delivered (...) by family members (144 patients) or standard management (143 patients). The primary efficacy outcome was the occurrence of delirium at any time during the course of hospitalisation. Three validated observers performed the event adjudication by using the confusion assessment method screening instrument.there were no significant differences in the baseline characteristics between the two groups. The primary outcome occurred in 5.6% of the patients in the intervention group and in 13.3% of the patients