Behavioral observations reflected on consultation requests from primary medical-surgical services: are they predictive of delirium diagnosis and outcomes?
OBJECTIVE
We studied 405 patients evaluated by the Psychosomatics Service to investigate whether the behavioral description as reflected on consultation request from primary medical-surgical teams could be utilized to predict the final clinical diagnosis of delirium. We explored whether outcomes differed in patient with delirium with different consultation requests.


METHODS
Patients with delirium (n=114) were divided into subtypes based on consultation requests for the management for cognitive dysfunction [altered mental status (AMS), n=46], for agitation or behavior disturbance (BEH, n=26), for depression (DEP, n=18), and for all other reasons (MISC, n=33). Adjusted multivariate regression models were used to examine group differences.


RESULTS
Consult requests for AMS had a high likelihood ratio (LR+=14.22) and requests for BEH had moderately high likelihood ratio (LR+=4.79) of receiving a diagnosis of delirium. The DEP group (n=18) tended to be younger and had higher 30-day readmission rates. The BEH group (n=26) had more comorbid systemic medical conditions, higher rate of being discharged to home, and lower mortality rate. Delirium subtypes did not show any significant difference in clinical outcomes.


CONCLUSIONS
Behavioral observations on consultation requests as formulated by primary medical-surgical teams may be useful in the classification of patients with delirium. Whether the behavioral observations on the request may be used to predict delirium outcomes deserves further research.
Xiong
Glen L
GL
Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817-1419, USA. gxiong@ucdavis.edu
Wiechers
Ilse R
IR
Bourgeois
James A
JA
Gagliardi
Jane P
JP
D000368:Aged; D003693:Delirium / Q000175:diagnosis* / Q000503:physiopathology*; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D019370:Observation; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012044:Regression Analysis; D012720:Severity of Illness Index