Delirium in the Emergency Department and Its Extension Into Hospitalization

Delirium is an acute confusional state characterized by fluctuating mental status,
inattention, and either disorganized thinking or an altered level of consciousness. The
prevalence of delirium in elderly patients is approximately 10% in emergency department (ED)
patients. Several hospital-based studies have shown delirium to be associated with worsening
mortality,longer hospital length of stay, higher health care costs,and poorer long-term
functional and cognitive function.

However, delirium in the ED remains poorly understood. Specifically, its natural course is
not well characterized and represents a critical gap in knowledge. Improving our
understanding is paramount for several reasons. If the majority of delirium persists beyond
the ED and is associated with long-term adverse outcomes, then routine delirium surveillance
in the busy ED environment can be justified. Understanding the natural course may also help
physicians identify delirious patients at highest risk for adverse outcomes and would be the
focus of future delirium interventions. Lastly, we don't know if all patients with delirium
require an admission. Understanding the natural course may help identify delirious patients
that can be safely discharged home and those who require a hospital admission.

Given this paucity of data, we are conducting this study with the following specific aims:
1) To describe the frequency in which delirium in the ED persists into hospitalization and
determine how patient factors and clinical factors affect delirium persistence. 2) To
determine how ED delirium duration affects 6-month outcomes. To achieve these aims, we will
perform a prospective cohort study thatwill enroll 125 older ED patients with delirium and a
random selection of 125 older ED patients without delirium; both groups will comprise of
admitted ED patients only. Once enrolled in the ED, we will assess patients for 7 days
during hospitalization and perform phone follow-up at 6-months.

Inclusion Criteria:

- 65 Years and older

- In an ED bed for less than 4 hours at the time of enrollment

- Any possibility of being admitted to the hospital

Exclusion Criteria:

- Refuse consent

- Have been previously enrolled

- Unarousable to verbal stimuli

- Have severe mental retardation or severe dementia characterized by being non-verbal
or unable to comprehend simple instructions at baseline

- Deaf

- Patient or surrogate is non-English speaking

- Discharged from the emergency department