title: Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition.
abstract: BACKGROUND
  The natural course and clinical significance of delirium in the emergency department (ED) is unclear.
  
  
  OBJECTIVE
  We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary care, academic medical center.
  
  
  METHODS
  ED patients ≥65 years old who were admitted to the hospital.
  
  
  METHODS
  The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders.
  
  
  RESULTS
  A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition.
  
  
  CONCLUSIONS
  Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes.
authors.affiliation: Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN, USA.|Department of Emergency Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.|Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Jin H
authors.initials: JH
authors.lastname: Han
authors.affiliation: Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN, USA.|Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA.|Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.|Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, USA.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Rameela
authors.initials: R
authors.lastname: Chandrasekhar
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Xulei
authors.initials: X
authors.lastname: Liu
authors.affiliation: Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN, USA.|Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA.|Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.|Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.affiliation: Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN, USA.|Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA.|Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.|Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.affiliation: Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN, USA.|Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA.|Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.|Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, USA.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: D000203:Activities of Daily Living; D003071:Cognition; D003072:Cognition Disorders; D003693:Delirium / Q000150:complications*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
keywords: delirium; emergency department; long-term cognition; long-term function