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Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes
Han JH, Zimmerman EE, Cutler N, Schnelle J, Morandi A, Dittus RS, Storrow AB, Ely EW.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2009-01-20
Topic: Risk, prevention and care in population studies
Objectives Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians (EPs). Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by EPs. The authors sought to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, to identify delirium risk factors in older ED patients, and to characterize delirium by psychomotor subtypes in the ED setting. Methods This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English-speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants (RAs). Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes. Results Inclusion and exclusion criteria were met in 303 patients, and 25 (8.3%) presented to the ED with delirium. The vast majority (92.0%, 95% confidence interval [CI] = 74.0% to 99.0%) of delirious patients had the hypoactive psychomotor subtype. Of the 25 patients with delirium, 19 (76.0%, 95% CI = 54.9% to 90.6%) were not recognized to be delirious by the EP. Of the 16 admitted delirious patients who were undiagnosed by the EPs, 15 (93.8%, 95% CI = 69.8% to 99.8%) remained unrecognized by the hospital physician at the time of admission. Dementia, a Katz Activities of Daily Living (ADL) Conclusions Delirium was a common occurrence in the ED, and the vast majority of delirium in the ED was of the hypoactive subtype. EPs missed delirium in 76% of the cases. Delirium that was missed in the ED was nearly always missed by hospital physicians at the time of admission. Using a delirium risk score has the potential to improve delirium screening efficiency in the ED setting.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Han, J. H., Zimmerman, E. E., Cutler, N., Schnelle, J., Morandi, A., Dittus, R. S., et al. (2009). Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. https://doi.org/10.1111/j.1553-2712.2008.00339.x
Vancouver
Han JH, Zimmerman EE, Cutler N, Schnelle J, Morandi A, Dittus RS, et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2009. doi:10.1111/j.1553-2712.2008.00339.x. PMID: 19154565.
BibTeX
@article{han2009-19154565,
author = {Han, J. H. and Zimmerman, E. E. and Cutler, N. and Schnelle, J. and Morandi, A. and Dittus, R. S. and Storrow, A. B. and Ely, E. W.},
title = {{Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes}},
journal = {Academic emergency medicine : official journal of the Society for Academic Emergency Medicine},
year = {2009},
doi = {10.1111/j.1553-2712.2008.00339.x},
pmid = {19154565},
url = {https://doi.org/10.1111/j.1553-2712.2008.00339.x}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
Key findings
- Results Inclusion and exclusion criteria were met in 303 patients, and 25 (8.3%) presented to the ED with delirium.
Why it matters
Among 303 older emergency department patients, 25 (8.3%) had delirium, and the study examined how often emergency and hospital physicians recognized it. It identifies risk factors and psychomotor subtypes of delirium in this setting.
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Study details
- Study designcross-sectional
- Participants303
- Effect size8.3%; 92.0%; 74.0% to 99.0%
- Evidence strengthLow
How this study scored 61/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Academic emergency medicine : official journal of the Society for Academic Emergency Medicine) |
| Journal's citation record | 2 / 4 | Academic Emergency Medicine: journal h-index 177 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2009 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 303 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Blinded or placebo-controlled (as stated in the record) |
| Times cited | 6 / 7 | Cited 438 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 23.1 citations a year over 19 year(s) since 2009 |
| Impact for its field and year | 4 / 6 | Cited 9.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 6 other studies in this library |
| Still being cited | 3 / 4 | Cited 60 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Eugene Wesley Ely: h-index 135 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Vanderbilt University: institution h-index 1,199 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 19154565) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 61 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1111/j.1553-2712.2008.00339.x
- PubMed: 19154565
- Original source →
- Free full text: Academic Emergency Medicine →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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