Diagnosing delirium in very elderly intensive care patients.
OBJECTIVE
To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10).


METHODS
Retrospective study.


METHODS
An ICU in a large metropolitan private hospital in Melbourne, Australia.


METHODS
English-speaking participants (n=348) 80+ years, admitted to ICU for >24 hours.


RESULTS
Medical files of ICU patients admitted October 2009-October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data. General patient characteristics, first onset of delirium symptoms, source of delirium information, administration of delirium medication, hospital and ICU length of stay, 90 day mortality were documented. Delirium was found in 11-29% of patients, the highest incidence identified by chart review. Patients diagnosed with delirium had higher 90 day mortality, and those meeting criteria for all three methods had longer hospital and ICU length of stay.


CONCLUSIONS
ICU delirium in the elderly is often under-reported and strategies are needed to improve staff education and diagnosis.
Cabrini Institute, Cabrini-Monash Department of Medicine, Cabrini Hospital, Malvern, VIC, Australia.
Natalie R
NR
Heriot
Cabrini Institute, Cabrini-Monash Department of Medicine, Cabrini Hospital, Malvern, VIC, Australia; Monash University, VIC, Australia.
Michele R
MR
Levinson
Cabrini Institute, Cabrini-Monash Department of Medicine, Cabrini Hospital, Malvern, VIC, Australia. Electronic address: AMills@Cabrini.com.au.
Amber C
AC
Mills
Cabrini Health, VIC, Australia.
Thinn Thinn
TT
Khine
Cabrini Institute, Cabrini-Monash Department of Medicine, Cabrini Hospital, Malvern, VIC, Australia.
Anthea L
AL
Gellie
Cabrini Institute, Cabrini-Monash Department of Medicine, Cabrini Hospital, Malvern, VIC, Australia.
Gaya
G
Sritharan
D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D038801:International Classification of Diseases / Q000145:classification; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000451:nursing* / Q000706:statistics & numerical data
Aged, 80 and over; Critical care; Delirium; Diagnostic and statistical manual of mental disorders; Intensive care units; International classification of diseases