Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel.
Department of Internal Medicine, Soroka Medical Center, P.O.B. 151, Beer-Sheva, 84101, Israel.
Isr J Health Policy Res. 2024 Apr 2;13(1):16. doi: 10.1186/s13584-024-00603-1.
Between 8-17% of older adults, and up to 40% of those arriving from nursing homes, present with delirium upon admission to the Emergency Department (ED). However, this condition often remains undiagnosed by ED medical staff. We investigated the prevalence of delirium among patients aged 65 and older admitted to the ED and assessed the impact of a prospective study aimed at increasing awareness.
The study was structured into four phases: a "pre-intervention period" (T0); an "awareness period" (T1), during which information about delirium and its diagnosis was disseminated to ED staff; a "screening period" (T2), in which dedicated evaluators screened ED patients aged 65 and older; and a "post-intervention period" (T3), following the departure of the evaluators. Delirium screening was conducted using the Brief Confusion Assessment Method (bCAM) questionnaire.
During the T0 and T1 periods, the rate of delirium diagnosed by ED staff was below 1%. The evaluators identified a delirium rate of 14.9% among the screened older adults during the T2 period, whereas the rate among those assessed by ED staff was between 1.6% and 1.9%. Following the evaluators' departure in the T3 period, the rate of delirium diagnosis decreased to 0.89%.
This study underscores that a significant majority of older adult delirium cases remain undetected by ED staff. Despite efforts to increase awareness, the rate of diagnosis did not significantly improve. While the presence of dedicated delirium evaluators slightly increased the diagnosis rate among patients assessed by ED staff, this rate reverted to pre-intervention levels after the evaluators left. These findings emphasize the necessity of implementing mandatory delirium screening during ED triage and throughout the patient's stay.
8-17%的老年人，以及高达 40%的从养老院来的人，在急诊科（ED）入院时会出现谵妄。然而，ED 的医务人员往往未能诊断出这种情况。我们调查了在 ED 入院的 65 岁及以上患者中谵妄的患病率，并评估了一项旨在提高认识的前瞻性研究的影响。
该研究分为四个阶段：“干预前阶段”（T0）；“意识阶段”（T1），在此期间向 ED 工作人员传播有关谵妄及其诊断的信息；“筛查阶段”（T2），在此期间，专门的评估人员对 65 岁及以上的 ED 患者进行筛查；以及“干预后阶段”（T3），评估人员离开后。使用简短的混乱评估方法（bCAM）问卷对谵妄进行筛查。
在 T0 和 T1 期间，ED 工作人员诊断的谵妄率低于 1%。在 T2 期间，评估人员在筛查的老年人中发现谵妄率为 14.9%，而 ED 工作人员评估的患者中，谵妄率在 1.6%至 1.9%之间。在 T3 期间评估人员离开后，谵妄的诊断率下降至 0.89%。
这项研究强调，急诊科工作人员未能发现绝大多数老年谵妄病例。尽管努力提高认识，但诊断率并没有显著提高。尽管有专门的谵妄评估人员，但评估人员增加了 ED 工作人员评估的患者的诊断率，但在评估人员离开后，诊断率又回到了干预前的水平。这些发现强调了在 ED 分诊和患者留观期间实施强制性谵妄筛查的必要性。
