• Valérie Boucher, Marie-Eve Lamontagne, Alexandra Nadeau, Pierre-Hugues Carmichael, Krishan Yadav, Philippe Voyer, Mathieu Pelletier, Émilie Gouin, Raoul Daoust, Simon Berthelot, Michèle Morin, Stéphane Lemire, Thien Tuong Minh Vu, Jacques Lee, and Marcel Émond.
• Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada; Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec city, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Laval, Québec, Canada; Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada.
• J Emerg Med. 2019 Oct 1; 57 (4): 535-542.

BackgroundIt is documented that health professionals from various settings fail to detect > 50% of delirium cases.ObjectiveThis study aimed to describe the proportion of unrecognized incident delirium in five emergency departments (EDs). Secondary objectives were to compare the two groups (recognized/unrecognized) and assess the impact of unrecognized delirium at 60 days regarding 1) unplanned consultations and 2) functional and cognitive decline.MethodThis is a sub-analysis of a multicenter prospective cohort study. Independent patients aged ≥ 65 years who tested negative for delirium on the initial interview with an ED stay ≥ 8 h were enrolled. Patients were assessed twice daily using the Confusion Assessment Method (CAM) and the Delirium Index up to 24 h into hospital admission. Medical records were reviewed to assess whether delirium was recognized or not.ResultsThe main study reported a positive CAM in 68 patients. Three patients' medical files were incomplete, leaving a sample of 65 patients. Delirium was recognized in 15.4% of our participants. These patients were older (p = 0.03) and female (p = 0.01) but were otherwise similar to those with unrecognized delirium. Delirium Index scores were higher in patients with recognized delirium (p = 0.01) and they experienced a more important functional decline at 60 days (p = 0.02). No association was found between delirium recognition and health care services utilization or decline in cognitive function.ConclusionsThis study confirms reports of high rates of missed or unrecognized delirium (84.6%) in ED patients compared to routine structured screening using the CAM performed by a research assistant. Patients with recognized delirium were older women with a greater severity of symptoms and experienced a more significant functional decline at 60 days.Copyright © 2019 Elsevier Inc. All rights reserved.

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