Comparing three approaches to delirium identification in older patients presenting to the emergency department

Early identification of hospitalised patients with or at risk for delirium is important to treat patients adequately. The aim of this study is to compare three approaches to delirium identification for identifying patients being at risk for or with a delirium during hospitalisation in a cohort of older patients presenting to the emergency department, including retrospectively extracted indicators of delirium based on prehospital care notes, by risk assessment (VMS), and screening instrument (4AT).

A single-centre cohort study was conducted with the use of data from patients 70 years and older from Acutelines, a hospital-based biobank. extended with extraction of documented prehospital indicators based on prehospital care notes and a hospital chart-based review as a reference standard to determine whether patients experienced delirium during hospitalisation. We compared the different approaches by calculating standard performance measures (e.g. sensitivity, specificity, and predictive values).

Data of 655 patients were included. Median age was 76 years, and 407 (62%) were male. During hospitalisation, 146 patients (22%) were identified as having a delirium. The positive likelihood ratios were 5.54 for the documented prehospital indicators, 1.55 for the VMS risk assessment, and 2.39 for the 4AT screening.

All three approaches, the documented prehospital indicators, the VMS risk assessment, and 4AT screening, are associated with delirium during hospitalisation. The documented prehospital indicators could be of added value, and we see this as a starting point for research into how the prehospital information could be used in the acute care pathway for older patients with or at risk for delirium.