Highlights
- •Delirium is a neuropsychiatric disorder, triggered by acute medical causes.
- •Only 72 of 2551 patients recruited in our study were diagnosed with ICD-9 delirium.
- •Neurocognitive deficits which may reflect delirium were instead frequently reported.
- •Neurocognitive deficits were strongly associated with in-hospital mortality.
- •Education to improve physician's knowledge of delirium is required.
Abstract
Background
Delirium is a neuropsychiatric disorder, triggered by medical precipitants causes.
Study aims were to describe the prevalence and impact on in-hospital mortality of
delirium identified through ICD-9 codes as well as evidence of neurocognitive deficits
demonstrated in a population of older patients admitted to acute medical wards.
Methods
This was a prospective cohort multicenter study of 2521 older patients enrolled in
the “Registro Politerapie SIMI (REPOSI)” during the years 2010 and 2012. The diagnosis
of delirium was obtained by ICD-9 codes. Cognitive function was evaluated with the
Short Blessed Test (SBT) and single SBT items were used as measures of deficits in
attention, orientation and memory. Combination of deficits in SBT items was used as
a proxy for delirium. Logistic regression was used to evaluate the association with
in-hospital mortality of delirium and combined deficits in SBT items.
Results
Delirium was coded in 2.9%, while deficits in attention, orientation, and memory were
found in 35.4%, 29.7% and 77.5% of patients. Inattention and either disorientation
or memory deficits were found in 14.1%, while combination of the 3 deficits in 19.8%.
Delirium, as per ICD-9 codes, was not a predictor of in-hospital mortality. In contrast,
objective deficits of inattention, in combination with orientation and memory disorders,
were stronger predictors after adjusting for covariates.
Conclusions
The documentation of delirium is poor in medical wards of Italian acute hospitals.
Neurocognitive deficits on objective testing (in a pattern suggestive of undiagnosed
delirium) should be used to raise awareness of delirium, given their association with
in-hospital mortality.
Keywords
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Article info
Publication history
Published online: August 31, 2015
Accepted:
August 10,
2015
Received in revised form:
August 5,
2015
Received:
April 30,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
