• Dtsch Arztebl Int · Mar 2022

    Structured Delirium Management in the Hospital-a Randomized Controlled Trial.

    • Julia Krämer, Katharina Nolte, Laura Zupanc, Stefan Schnitker, Anna Roos, Christopher Göpel, Janina Santos Cid, Kirsten Eichler, Thomas van den Hooven, Georg Hempel, Hermann-Joseph Pavenstädt, Christoph Klaas, Georg Gosheger, Michael J Raschke, Heinz Wiendl, and Thomas Duning.
    • Department of Neurology and Institute of Translational Neuroscience, Münster University Medical Center (UKM).
    • Dtsch Arztebl Int. 2022 Mar 18; 119 (11): 188194188-194.

    BackgroundDelirium is a common and serious complication of inpatient hospital care in older patients. The current approaches to prevention and treatment followed in German hospitals are inconsistent. The aim of this study was to test the effectiveness of a standardized multiprofessional approach to the management of delirium in inpatients.MethodsThe patients included in the study were all >65 years old, were treated for at least 3 days on an internal medicine, trauma surgery, or orthopedic ward at Münster University Hospital between January 2016 and December 2017, and showed cognitive deficits on standardized screening at the time of admission (a score of ≤=25 on the Montreal Cognitive Assessment [MoCA] test). Patients in the intervention group received standardized delirium prevention and treatment measures; those in the control group did not. The primary outcomes measured were the incidence and duration of delirium during the hospital stay; the secondary outcomes measured were cognitive deficits relevant to daily living at 12 months after discharge (MoCA and Instrumental Activities of Daily Living [I-ADL]).ResultsThe data of 772 patients were analyzed. Both the rate and the duration of delirium were lower in the intervention group than in the control group (6.8% versus 20.5%, odds ratio 0.28, 95% confidence interval [0.18; 0.45]; 3 days [interquartile range, IQR 2-4] versus 6 days [IQR 4-8]). A year after discharge, the patients with delirium in the intervention group showed fewer cognitive deficits relevant to daily living than those in the control group (I-ADL score 2.5 [IQR 2-4] versus 1 [IQR 1-2], P = 0.02).ConclusionStructured multiprofessional management reduces the incidence and duration of delirium and lowers the number of lasting cognitive deficits relevant to daily living after hospital discharge.

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