Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan

被引:4
作者
Damanti, Sarah [1 ,6 ]
Bozzolo, Enrica [1 ]
Franchini, Stefano [2 ]
Frangi, Claudia [3 ]
Ramirez, Giuseppe Alvise [4 ]
Pedroso, Carla [1 ]
Di Lucca, Giuseppe [1 ]
Scotti, Raffaella [1 ]
Valsecchi, Davide [2 ]
Cilla, Marta [1 ]
Cinel, Elena [3 ]
Santini, Chiara [3 ]
Castellani, Jacopo [3 ]
Manzo, Emanuela [3 ]
Vadruccio, Stefania [3 ]
Spessot, Marzia [2 ]
Borghi, Giovanni [4 ]
Monti, Giacomo [1 ,4 ]
Landoni, Giovanni [3 ,5 ]
Rovere-Querini, Patrizia [3 ,4 ]
Yacoub, Mona-Rita [4 ]
Tresoldi, Moreno [1 ]
机构
[1] IRCCS San Raffaele Inst, Unit Gen Med & Adv Care, Milan, Italy
[2] IRCCS San Raffaele Sci Inst, Emergency Dept, Milan, Italy
[3] Univ Vita Salute San Raffaele, Milan, Italy
[4] IRCCS San Raffaele Sci Inst, Unit Immunol Rheumatol Allergy & Rare Dis, Milan, Italy
[5] IRCCS San Raffaele Sci Inst, Dept Anaesthesia & Intens Care, Milan, Italy
[6] Osped San Raffaele, 542, Milan, Italy
关键词
delirium; COVID-19; emergency department; OLDER; CONFUSION; ADULTS;
D O I
10.1136/emermed-2021-211749
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundRespiratory infections can be complicated by acute brain failure. We assessed delirium prevalence, predictors and outcomes in COVID-19 ED patients. MethodsThis was a retrospective observational study conducted at the San Raffaele ED (Italy). Patients age >18 years attending the ED between 26 February 2020 and 30 May 2020 and who had a positive molecular nasopharyngeal swab for SARS-CoV-2 were included. The Chart-Based Delirium Identification Instrument (CHART-DEL) was used to retrospectively assess delirium. Univariable and multivariable logistic regression analyses were used to evaluate delirium predictors. Univariable binary logistic regression analyses, linear regression analyses and Cox regression analyses were used to assess the association between delirium and clinical outcomes. Age-adjusted and sex-adjusted models were then run for the significant predictors of the univariable models. ResultsAmong the 826 included patients, 123 cases (14.9%) of delirium were retrospectively detected through the CHART-DEL method. Patients with delirium were older (76.9 +/- 13.15 vs 61.3 +/- 14.27 years, p<0.001) and more frequently living in a long-term health facility (32 (26%) vs 22 (3.1%), p<0.001). Age (OR 1.06, 95% CI 1.04 to 1.09, p<0.001), dementia (OR 17.5, 95% CI 7.27 to 42.16, p<0.001), epilepsy (OR 6.96, 95% CI 2.48 to 19.51, p<0.001) and the number of chronic medications (OR 1.09, 95% CI 1.01 to 1.17, p=0.03) were significant predictors of delirium in multivariable analyses. Delirium was associated with increased in-hospital mortality (adjusted HR 2.16, 95% CI 1.55 to 3.03, p<0.001) and with a reduced probability of being discharged home compared with being institutionalised (adjusted OR 0.39, 95% CI 0.25 to 0.61, p<0.001). ConclusionsChart review frequently identified ED delirium in patients with COVID-19. Age, dementia, epilepsy and polypharmacy were significant predictors of ED delirium. Delirium was associated with an increased in-hospital mortality and with a reduced probability of being discharged home after hospitalisation. The findings of this single-centre retrospective study require validation in future studies.
引用
收藏
页码:202 / 209
页数:8
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