An Epidemiological and Clinical Analysis of Patients Presenting with Delirium in the Emergency Department: A Prospective Single Center Observational Study

Abstract

Background: Delirium is a state of acute brain dysfunction. It is one of the most common diagnoses encountered in the Emergency Department(ED), but frequently missed or under-evaluated. In developing countries like India, there is extreme paucity of reliable research data of patients presenting with delirium in the ED.Objectives: To evaluate the demographics and analyse the risk factors, triggers and clinical features in patients confirmed with delirium, attending the ED.Methods: Patients aged ≥18 years, attending the ED, of a tertiary care medical college hospital, from November 2020 to April 2021, were screened with Delirium Triage Screen, then confirmed for delirium by brief Confusion Assessment Method. These patients were classified into psychomotor subtypes on the basis of Richmond Agitation-Sedation Scale and into severity subtypes based on Delirium Rating Scale-revised-98 score. A wide range of demographic, epidemiological and clinical data was compiled and analyzed for statistical significance.Results: A total of 1660 patients were included. Almost 30% were young adults (<50 years age), while 61.5% patients were males. Hypoactive delirium was the most common psychomotor subtype. The younger adults and males predominantly showed delirium with less severity while females had more of severe delirium. The commonest risk factor was a recent decrease in food intake. Vomiting was the commonest presenting symptom. Hyponatremia was the commonest laboratory abnormality. Conclusion: Recognizing delirium by rapid validated methods and treating it appropriately in time, while working in a busy ED setup, will help in reducing the morbidity and mortality associated with this condition.