Structural brain lesions and delirium in geriatric emergency department patients: A matched case-control study

Delirium affects up to one-third of older adults in the emergency department (ED) and is frequently underrecognized. Head CT obtained during ED evaluation may reveal structural brain abnormalities in this population. This study evaluated whether structural lesions identified on head CT are associated with delirium in older ED patients.

We conducted a retrospective matched case-control study of adults aged ≥65 years who underwent delirium screening and head CT within 24 h of ED arrival. Delirium was defined by a positive Delirium Triage Screen followed by a positive Brief Confusion Assessment Method. Cases were matched 1:1 to non-delirious controls by age, sex, Emergency Severity Index, and chief complaint. Structural lesions were identified through radiology report review. Conditional logistic regression estimated associations between lesion presence and delirium, adjusting for pre-existing dementia and comorbidity.

A total of 244 patients were included (122 delirium cases and 122 matched controls). Structural brain lesions were present in 55.7% of delirium cases compared with 37.7% of controls. The presence of any structural brain lesion was associated with higher odds of delirium (unadjusted OR = 2.2, 95% CI: 1.3-3.7; adjusted OR = 2.1, 95% CI: 1.1-3.8). Ischemic lesions were the most frequently identified abnormality.

Structural brain lesions on head CT were associated with higher odds of delirium among older ED patients. When clinically indicated, imaging findings may complement bedside screening and known risk factors but do not establish additional diagnostic value beyond standard delirium assessment.