Key Words: delirium, inpatients, internal medicine
Abstract
INTRODUCTION
Delirium is a common neurocognitive syndrome that takes place during hospitalizations, associated with worse global outcomes in patients who present it. Despite this, it is usually under-recognized as a disease that needs specific treatment.
OBJECTIVES
To determine the rate of prevalence of delirium in Internal Medicine Service patients and evaluate missed diagnosis of the syndrome made by attending physicians, medical residents or interns in charge.
METHODS
This is a descriptive observational study carried out in the Internal Medicine Service of Dr. Eduardo Pereira Hospital (April 12 - May 12, 2014) evaluating 125 patients who were admitted to this service. Through the Confusion Assessment Method Instrument, the prevalence of delirium disease and the number of missed diagnosis was established.
RESULTS
One hundred and two (102) patients met the inclusion criteria. Nineteen (19) (18.6%) of them were diagnosed with delirium. In the diagnosed patient group, 13 (68.4%) were women. Delirium diagnosis was missed in eight patients (42.1%).
CONCLUSIONS
The prevalence of delirium in this specific Hospital is as expected, according to the literature. Considering the diagnostic tools available, it is crucial to train health workers to improve recognition and management of this syndrome.
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INTRODUCCIÓN
El delirium es un síndrome neurocognitivo frecuente en pacientes hospitalizados, que se asocia en forma categórica e independiente a peores resultados globales en quienes lo presentan. A pesar de esto, suele ser subvalorado y no reconocido como un cuadro que requiere un manejo específico, independiente de la causa que lo origina.
OBJETIVOS
Determinar la tasa de prevalencia de delirium en los pacientes ingresados a un servicio de medicina y, secundariamente, el subdiagnóstico del cuadro por parte del médico tratante, residente o interno de medicina.
MÉTODOS
Estudio observacional descriptivo realizado en el Servicio de Medicina del Hospital Dr. Eduardo Pereira a los 125 pacientes ingresados entre el 12 de abril y 12 mayo de 2014. A través de la herramienta diagnóstica Confusion Assessment Method Instrument, se determinó la tasa de prevalencia del delirium y de casos subdiagnosticados.
RESULTADOS
Ciento dos pacientes cumplieron los criterios de inclusión. De éstos, 19 (18,6%) pacientes fueron diagnosticados con delirium. En el grupo de pacientes diagnosticados, 13 (68,4%) eran de sexo femenino. El subdiagnóstico se presentó en ocho pacientes (42,1%).
CONCLUSIONES
La prevalencia de delirium en este centro está dentro de lo esperable, según la literatura. Considerando la disponibilidad de herramientas para realizar su diagnóstico, es necesario instruir al equipo de salud para mejorar el reconocimiento y manejo de este cuadro dada su importancia pronóstica.
Authors:
Ana Carolina González Pezoa[1], Bernardita Claudia Carrillo Venezian[1], Sandra Castillo Rojas[1,2]
Affiliation:
[1] Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
[2] Servicio de Medicina, Hospital Dr. Eduardo Pereira, Valparaíso, Chile
E-mail: a.cari.gpz@gmail.com
Author address:
[1] Hontaneda 2653
Valparaíso
Chile
Citation: González Pezoa AC, Carrillo Venezian BC, Castillo Rojas S. Prevalence of delirium in hospitalized patients from an internal medicine service. Medwave 2015 Nov;15(10):e6311 doi: 10.5867/medwave.2015.10.6311
Submission date: 9/7/2015
Acceptance date: 23/10/2015
Publication date: 11/11/2015
Origin: not requested
Type of review: reviewed by four external peer reviewers, double-blind
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- Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006 Jul;35(4):350-64. | PubMed |
- Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun 3;350:h2538. | CrossRef | PubMed |
- Tobar C, Beddings C, Vallejo G, Martínez F. Prevalencia de Delirium y Diagnóstico por los Médicos Tratantes. Revista ANACEM. 2010;4(29):82-85. | Link |
- Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med. 1993 Sep 15;119(6):474-81. | PubMed |
Han JH, Wilson A, Ely EW. Delirium in the older emergency department patient: a quiet epidemic. Emerg Med Clin North Am. 2010 Aug;28(3):611-31. | CrossRef | PubMed |Marcantonio ER. In the clinic. Delirium. Ann Intern Med. 2011 Jun 7;154(11):ITC6-1. | CrossRef | PubMed |Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15;113(12):941-8. | PubMed |O'Keeffe ST, Lavan JN. Clinical significance of delirium subtypes in older people. Age Ageing. 1999 Mar;28(2):115-9. | PubMed |Kiely DK, Jones RN, Bergmann MA, Marcantonio ER. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci. 2007 Feb;62(2):174-9. | PubMed |Alvarez Fernandez B, Formiga F, Gomez R. Delirium in hospitalised older persons: review. J Nutr Health Aging. 2008 Apr;12(4):246-51. | PubMed |Carrasco M, Hoyl T, Marín PP, Hidalgo J, Lagos C, Longton C, et al. [Delirium in Chilean elderly inpatients: an overlooked problem]. Rev Med Chil. 2005 Dec;133(12):1449-54. | PubMed |Aris R, Papuzinski C, Martínez F. Multicomponent interventions in preventing incident delirium in elderly inpatients: a critical appraisal of literature. Medwave 2013;13(9):e5822. | CrossRef |Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005594. | PubMed | Link |Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The Confusion Assessment Method: a systematic review of current usage. J Am Geriatr Soc. 2008 May;56(5):823-30. | CrossRef | PubMed |Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006 Jul;35(4):350-64. | PubMed |Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun 3;350:h2538. | CrossRef | PubMed |Tobar C, Beddings C, Vallejo G, Martínez F. Prevalencia de Delirium y Diagnóstico por los Médicos Tratantes. Revista ANACEM. 2010;4(29):82-85. | Link |Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med. 1993 Sep 15;119(6):474-81. | PubMed |
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