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. 2016 Oct;31(10):1164-71.
doi: 10.1007/s11606-016-3671-9. Epub 2016 Jun 3.

Quantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration

Sarinnapha M Vasunilashorn  1   2 , Edward R Marcantonio  3   4   5 , Yun Gou  5 , Margaret A Pisani  6 , Thomas G Travison  3   4   5 , Eva M Schmitt  5 , Richard N Jones  7 , Sharon K Inouye  3   4   5
Affiliations

Quantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration

Sarinnapha M Vasunilashorn et al. J Gen Intern Med. 2016 Oct.

Abstract

Background: The ability to determine which episodes of delirium are likely to lead to poor clinical outcomes has remained a major area of challenge.

Objective: To quantify delirium severity and course over an entire hospitalization using several measures, and to evaluate their predictive validity for 30- and 90-day outcomes post-discharge.

Design: Two prospective cohort studies.

Participants: Analysis was conducted in two independent cohorts of adult patients aged ≥70.

Main measures: Nine delirium episode severity measures were examined: (1) measures reflecting delirium intensity (peak Confusion Assessment Method-Severity [CAM-S] and mean CAM-S score), (2) a measure reflecting delirium intensity and duration (sum of all CAM-S scores, sum of all CAM-S scores on delirium days only, peak CAM-S score x days with delirium), (3) measures requiring information on delirium duration and delirium at discharge (total number of delirium days, percentage of delirium days, delirium at discharge), and (4) a measure of cognitive change. Associations of the delirium episode severity measures with 30- and 90-day post-hospital outcomes (death, nursing home placement, and readmission) relevant to delirium were examined.

Key results: The delirium episode severity measure that required information on both delirium intensity and duration (sum of all CAM-S scores) was the most strongly associated with 30- and 90-day post-hospital outcomes. Using this measure, the relative risk [95 % confidence interval] for death at 30-days increased across levels of sum of all CAM-S scores from 1.0 (referent) to 2.1 [0.8, 5.4] for 'low,' to 2.9 [1.2, 7.1] for 'moderate,' to 6.4 [2.9, 14.0] for 'high' (p for trend <.01).

Conclusions: The delirium episode severity measure that included both intensity and duration had the strongest association with important post-hospital outcomes.

Keywords: cognitive change; delirium severity; duration; intensity.

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Conflict of interest statement

The authors declare no conflicts of interest.

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