Underdiagnosed Delirium on Elderly Patients in the Emergency Room Principal Author

Introduction: Delirium is a fluctuant, transitional and acute affection of cognition and attention, with multifactorial aetiologies. It is a medical emergency and requires an integral evaluation to identify the underlying causes. In elderly people, over 65 years old, the incidence of Delirium oscillates greatly between 14% to 24% at the moment of hospitalization and 6% to 56% during the time of hospitalization. The prevalence of Delirium acquired in the community oscillates from 1% to 2%. However, this prevalence increases as high as 10% when entering the emergency department. The identification of Delirium in the emergency department usually is not realized, leading to a delay in the instauration of treatment, which increases morbidity and mortality, leading to prolonged permanency at the hospital. Material and methods: A prospective study with no probabilistic sample was evaluated through logistic regression analysis, central tendency measurements, standard deviation and comparison between means. This study included 118 patients over 65 years old who were admitted to the emergency service of the Hospital General de Zona #50 (HGZ #50) in San Luis Potosi, S.L.P. Mexico; between the months of March and May of the year 2016. We utilized the Confusion Assessment Method (CAM) scale to evaluate the presence or absence of Delirium and its clinical subtypes in these 188 patients. T-Test was utilized to recognize the existence of under diagnose of Delirium. Objective: To identify the frequency of underdiagnose cases of Delirium in elderly patients in the emergency service of the HGZ#50. Results: A total of 118 patients over 65 years old admitted to the emergency service were included in the study, having 51.7% males (n = 61) and 48.3% females (n = 57). From the total number of patients, in only 26 patients Delirium was diagnosed thought CAM scale. Nevertheless, in only 6 patients (5.1%) the diagnosis was recorded in their medical record. Utilizing T-Test, to compare the 26 patients with Delirium and the 6 patients with Delirium recorded in their medical record we obtained a p = 0.014 as a result meaning that diagnosis of Delirium is under diagnosed. Conclusions: In this study Delirium was present in 22% of the 118 patients analysed and only 5.1% had the diagnosis of Delirium recorded in the medical record. This result shows that underdiagnose of Delirium is not uncommon. We, therefore, recommend the use of CAM scale in patients over 65 years old to diagnose Delirium, during their stay in the emergency service, paying special attention to patients with metabolic affections, mixed syndromes and age over 76 years old. Identifying the presence of Delirium in patients admitted in the emergency room could improve the prognostic and also could decrease the time hospitalized by initiating treatment promptly.