RT Journal Article
SR Electronic
T1 Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 202
OP 209
DO 10.1136/emermed-2021-211749
VO 40
IS 3
A1 Sarah Damanti
A1 Enrica Bozzolo
A1 Stefano Franchini
A1 Claudia Frangi
A1 Giuseppe Alvise Ramirez
A1 Carla Pedroso
A1 Giuseppe Di Lucca
A1 Raffaella Scotti
A1 Davide Valsecchi
A1 Marta Cilla
A1 Elena Cinel
A1 Chiara Santini
A1 Jacopo Castellani
A1 Emanuela Manzo
A1 Stefania Vadruccio
A1 Marzia Spessot
A1 Giovanni Borghi
A1 Giacomo Monti
A1 Giovanni Landoni
A1 Patrizia Rovere-Querini
A1 Mona-Rita Yacoub
A1 Moreno Tresoldi
YR 2023
UL http://emj.bmj.com/content/40/3/202.abstract
AB 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.Data are available upon reasonable request.