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Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan
  1. Sarah Damanti1,
  2. Enrica Bozzolo1,
  3. Stefano Franchini2,
  4. Claudia Frangi3,
  5. Giuseppe Alvise Ramirez4,
  6. Carla Pedroso1,
  7. Giuseppe Di Lucca1,
  8. Raffaella Scotti1,
  9. Davide Valsecchi2,
  10. Marta Cilla1,
  11. Elena Cinel3,
  12. Chiara Santini3,
  13. Jacopo Castellani3,
  14. Emanuela Manzo3,
  15. Stefania Vadruccio3,
  16. Marzia Spessot2,
  17. Giovanni Borghi4,
  18. Giacomo Monti1,4,
  19. Giovanni Landoni3,5,
  20. Patrizia Rovere-Querini3,4,
  21. Mona-Rita Yacoub4,
  22. Moreno Tresoldi1
  1. 1 Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
  2. 2 Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
  3. 3 Vita-Salute San Raffaele University, Milan, Italy
  4. 4 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
  5. 5 Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Dr Sarah Damanti, San Raffaele Hospital, Milano, 542, Italy; damanti.sarah{at}


Background Respiratory infections can be complicated by acute brain failure. We assessed delirium prevalence, predictors and outcomes in COVID-19 ED patients.

Methods This 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.

Results Among 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).

Conclusions Chart 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.

  • delirium
  • COVID-19
  • emergency department

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Data availability statement

Data are available upon reasonable request.

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  • M-RY and MT are joint senior authors.

  • Handling editor Mary Dawood

  • Contributors All authors made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be submitted. SD is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.