Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan.

Autor:	Damanti S; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy damanti.sarah@hsr.it., Bozzolo E; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy., Franchini S; Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy., Frangi C; Vita-Salute San Raffaele University, Milan, Italy., Ramirez GA; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy., Pedroso C; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy., Di Lucca G; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy., Scotti R; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy., Valsecchi D; Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy., Cilla M; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy., Cinel E; Vita-Salute San Raffaele University, Milan, Italy., Santini C; Vita-Salute San Raffaele University, Milan, Italy., Castellani J; Vita-Salute San Raffaele University, Milan, Italy., Manzo E; Vita-Salute San Raffaele University, Milan, Italy., Vadruccio S; Vita-Salute San Raffaele University, Milan, Italy., Spessot M; Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy., Borghi G; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy., Monti G; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy.; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy., Landoni G; Vita-Salute San Raffaele University, Milan, Italy.; Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Rovere-Querini P; Vita-Salute San Raffaele University, Milan, Italy.; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy., Yacoub MR; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy., Tresoldi M; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy.
Jazyk:	angličtina
Zdroj:	Emergency medicine journal : EMJ [Emerg Med J] 2023 Mar; Vol. 40 (3), pp. 202-209. Date of Electronic Publication: 2022 Dec 15.
DOI:	10.1136/emermed-2021-211749
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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