Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jun;65(6):1333-1338.
doi: 10.1111/jgs.14824. Epub 2017 Mar 6.

Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition

Jin H Han  1   2   3 , Eduard E Vasilevskis  1   3   4   5 , Rameela Chandrasekhar  6 , Xulei Liu  6 , John F Schnelle  1   3   7   5 , Robert S Dittus  1   3   7   5 , E Wesley Ely  1   3   8   5
Affiliations

Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition

Jin H Han et al. J Am Geriatr Soc. 2017 Jun.

Abstract

Background: The natural course and clinical significance of delirium in the emergency department (ED) is unclear.

Objectives: We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition.

Design: Prospective cohort study.

Setting: Tertiary care, academic medical center.

Participants: ED patients ≥65 years old who were admitted to the hospital.

Measurements: The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders.

Results: A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition.

Conclusions: Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes.

Keywords: delirium; emergency department; long-term cognition; long-term function.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Enrollment flow diagram. ED, emergency department. Patients who were non-verbal or unable to follow simple commands prior to the acute illness were considered to have end-stage dementia.
Figure 2
Figure 2
a. Relationship between emergency department (ED) delirium duration and 6-month function as measured by the Older American Resources and Services Activities of Daily Living (OARS ADL) scale adjusted for baseline OARS ADL, age, dementia, comorbidity burden, severity of illness, nursing home residence, central nervous system diagnoses, and incident delirium. Lower OARS ADL scores indicated poorer function. For every additional ED delirium duration day, the OARS ADL decreased by 0.63 (95%CI: −1.01 to −0.24) points. b. The relationship between ED delirium duration and 6-month cognition as measured by the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) adjusted for baseline IQCODE, age, baseline function, comorbidity burden, severity of illness, nursing home residence, central nervous system diagnoses, and incident delirium. Higher IQCODE scores indicated poorer cognition. For every ED delirium duration day, the patient’s 6-month IQCODE significantly increased by 0.06 points (95%CI: 0.01 to 0.10) indicating poorer 6-month cognition.
See this image and copyright information in PMC

References

    1. Han JH, Shintani A, Eden S, et al. Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med. 2010;56:244–252. - PMC - PubMed
    1. Han JH, Zimmerman EE, Cutler N, et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med. 2009;16:193–200. - PMC - PubMed
    1. Han JH, Eden S, Shintani A, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med. 2011;18:451–457. - PMC - PubMed
    1. Schuur JD, Venkatesh AK. The growing role of emergency departments in hospital admissions. N Engl J Med. 2012;367:391–393. - PubMed
    1. Lamantia MA, Messina FC, Hobgood CD, et al. Screening for Delirium in the Emergency Department: A Systematic Review. Ann Emerg Med. 2013 - PubMed