Kwant, M. (Marieke) (2012) Delier op de Spoedeisende hulp : Een frequent gemiste diagnose. thesis, Medicine.
Full text available on request.Abstract
Background: Delirium forms a significant problem in our healthcare system. The consequences are serious and increase short and long term mortality. The incidence and recognition of delirium is an indicator of quality of care. The Emergency department could play a key role in detection of a delirium. Methods: This cohort study was conducted at an Emergency department of a tertiary care, university hospital from April till August 2012. This study contained both retrospective and prospective approaches to determine the incidence of delirium at the Emergency department. By extracting medical files of patients aged 70 years and older, who had visited the Emergency department from April till May 2012, retrospective determination of delirium was conducted. From June till August, the de Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was used to determine delirium in patients aged 70 years and older. In both groups patients were excluded when they did not give their consent, did not speak or understand Dutch, were previously enrolled, were not able to follow the commands of the CAM-ICU due to preexisting problems , were admitted because of a hip fracture and when they were too severely ill or underwent an emergency Intervention. Another aim was to validate the CAM-ICU. Every positive CAM-ICU-score and every fifth negative score was checked by a blinded experienced clinician from the geriatric department using the Diagnostic and Statistical Manual of Mental Disorders-IV-criteria (DSM-IV). The Rapid Emergency Medicine Score (REMS) was calculated to display the severity of illness of every patient. The preexisting comorbidity was shown in the Charlson Comorbidity Index. The length of hospital stay was also listed. The Independent-samples-test and the Chi-square-test were used to detect differences between the two groups and differences within the groups. The duration of hospital stay was shown in a Kaplan-Meier-curve. A potential difference in hospital stay was estimated using the Log-Rank-test. Results: The incidence of delirium in the prospective group was 10.04%. Patients with delirium had a higher comorbidity-rate (p=0.001) and a higher REMS (p=0.003). There was no difference in duration of hospital stay between patients with and without delirium (p=0.063). In the retrospective group 2.85% of the patients were diagnosed with delirium. This suggest that 72% of all deliriums were missed. The sensitivity of the CAM-ICU was 100% and the specificity was 97.6%. Conclusion: The diagnosis of delirium is frequently missed in the Emergency department. The CAM-ICU seems to be a good screening method to detect delirium and suitable in the clinical setting of the Emergency department.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Maaten, Dr. J.C. ter and Centrale Spoedopvang, UMC Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/979 |
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