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. 2025 Mar 11:S0196-0644(25)00064-2.
doi: 10.1016/j.annemergmed.2025.02.003. Online ahead of print.

Outcomes of Older Adults With Delirium Discharged From the Emergency Department

Annelise S Howick  1 , Piayeng Thao  1 , Kayla P Carpenter  1 , Madeline A Boie  1 , Ian Ward A Maia  1 , Aidan F Mullan  2 , Susan M Bower  3 , Allyson K Palmer  4 , Christopher R Carpenter  5 , Shan W Liu  6 , Molly M Jeffery  7 , Fernanda Bellolio  8
Affiliations

Outcomes of Older Adults With Delirium Discharged From the Emergency Department

Annelise S Howick et al. Ann Emerg Med. .

Abstract

Study objective: To compare 30-day mortality and return emergency department (ED) visits among older adults with delirium who are discharged home with those discharged home without delirium and those who are admitted to the hospital with and without delirium.

Methods: Adults aged 75 and older years were assessed for delirium using the Delirium Triage Screen followed by the Brief Confusion Assessment Method. We evaluated outcomes including return visits and 30-day mortality. Models were adjusted by age, sex, dementia, Modified Early Warning Score, and ED length of stay and summarized with adjusted relative risk (aRR) and 95% confidence intervals (CIs).

Results: The study included 22,940 visits. Among them, 202 (0.9%) delirium-positive patients were discharged, and 730 (3.2%) were admitted to the hospital to non-ICU and nonmonitored beds. Discharged patients with delirium had higher 30-day mortality (aRR 2.86, 95% CI 2.04 to 4.00) and were more likely to return to the ED within 30 days (aRR 1.52, 95% CI 1.43 to 1.61) compared with those discharged without delirium. Discharged delirium-positive patients were more likely to return to the ED within 30 days than hospitalized delirium-positive patients (aRR 1.92, 95% CI 1.41 to 1.92), though they experienced lower 30-day mortality (aRR 0.67, 95% CI 0.47 to 0.93). Age, sex, Modified Early Warning Score, dementia, and length of stay were not associated with mortality or ED return.

Conclusion: Patients discharged with delirium experienced a 3-fold increase in mortality within 30 days compared with those discharged without delirium. These findings suggest a need for more precise discharge criteria and enhanced follow-up care for delirious patients to improve safety. Implementing structured screening and tailored postdischarge support could reduce adverse outcomes in this population.

Keywords: Dementia; Frailty; Geriatrics, delirium; Mortality; Older adult.

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Conflict of interest statement

CONFLICTS OF INTEREST: CRC is Associate Editor for the Journal of the American Geriatrics Society and Deputy Editor for Academic Emergency Medicine, serves on the Society for Academic Emergency Medicine Guidelines for Reasonable and Appropriate Care in the Emergency Department committee, serves on the American College of Emergency Physicians Clinical Policy Committee, is Chair of the American College of Emergency Physician’s Geriatric Emergency Department Accreditation Advisory Board, serves on the Clinician-Scientist Transdisciplinary Aging Research Leadership Core, and is an editor for the American College of Emergency Physician’s MyEMCert program.

References

    1. Nagaraj G, Burkett E, Hullick C, Carpenter CR, Arendts G. Is delirium the medical emergency we know least about? Emerg Med Australas 2016; 28(4): 456–8. - PubMed
    1. Lee S, Howard MA 3rd, Han JH. Delirium and Delirium Prevention in the Emergency Department. Clin Geriatr Med 2023; 39(4): 535–51. - PMC - PubMed
    1. Carpenter CR, Hammouda N, Linton EA, et al. Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement. Acad Emerg Med 2021; 28(1): 19–35. - PMC - PubMed
    1. Carpenter CR, Shah MN, Hustey FM, Heard K, Gerson LW, Miller DK. High yield research opportunities in geriatric emergency medicine: prehospital care, delirium, adverse drug events, and falls. J Gerontol A Biol Sci Med Sci 2011; 66(7): 775–83. - PMC - PubMed
    1. Lee S, Chen H, Hibino S, et al. Can we improve delirium prevention and treatment in the emergency department? A systematic review. J Am Geriatr Soc 2022; 70(6): 1838–49. - PMC - PubMed

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