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Underdiagnosis of delirium in the elderly in acute care hospital settings: lessons not learned
Author(s) -
Ritter Simone R.F.,
Cardoso Anne F.,
Lins Marina M.P.,
Zoccoli Thayana L.V.,
Freitas Marco Polo D.,
Camargos Einstein F.
Publication year - 2018
Publication title -
psychogeriatrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.647
H-Index - 32
eISSN - 1479-8301
pISSN - 1346-3500
DOI - 10.1111/psyg.12324
Subject(s) - delirium , medicine , dementia , gold standard (test) , cross sectional study , confusion , multivariate analysis , stroke (engine) , emergency medicine , psychiatry , pediatrics , psychology , disease , pathology , mechanical engineering , engineering , psychoanalysis
Background Delirium is a common and poorly diagnosed cause of behavioral change in elderly. This study aimed to estimate the prevalence, diagnostic accuracy and factors associated with the onset of delirium in the elderly admitted to an urgency unit. Methods Cross‐sectional study including clinically stable subjects aged ≥60 years between April and June of 2014. Diagnosis of delirium based on the Confusion Assessment Method (CAM, gold standard) was compared to the subjective assessment made by physicians on duty as recorded in the medical chart. Association of sociodemographic, psychological/behavioural, and clinical variables with delirium was assessed using multivariate analysis. Results A sample of 110 participants with a mean age of 72.7 ± 8.3 years was studied. Of these, 56.4% were men and 28.2% had a diagnosis of delirium on CAM. Significant associations were observed between delirium and male gender ( P ‐value = 0.019), poor or very poor self‐perception of health ( P ‐value = 0.033), previous diagnosis of dementia ( P ‐value = 0.001), previous history of stroke ( P ‐value = 0.014), and acute bacterial infection ( P ‐value = 0.008). Physician diagnosis had a sensitivity of 35.5%, specificity of 100%, and accuracy of 81.8% to detect delirium. Rate of misdiagnosis was 64.5%. Conclusion Delirium was underdiagnosed in this urgent care hospital setting.