• Emmanuel Canet, Sobia Amjad, Raymond Robbins, Jane Lewis, Michelle Matalanis, Daryl Jones, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
• Intern Med J. 2019 Dec 1; 49 (12): 1496-1504.

BackgroundDelirium is common in hospitalised patients but its epidemiology remains poorly characterised.AimsTo test the hypothesis that patient demographics, clinical phenotype, management and outcomes of patient with delirium in hospital ward patients differ from intensive care unit (ICU) patients.MethodsRetrospective cohort of patients admitted to an Australian university-affiliated hospital between March 2013 and April 2017 and coded for delirium at discharge using the International Classification of Diseases System, 10th revision, criteria.ResultsAmong 61 032 hospitalised patients, 2864 (4.7%) were coded for delirium. From these, we studied a random sample of 100 ward patients and 100 ICU patients. Ward patients were older (median age: 84 vs 65 years; P < 0.0001), more likely to have dementia (38% vs 2% for ICU patients; P < 0.0001) and less likely to have had surgery (24% vs 62%; P < 0.0001). Of ward patients, 74% had hypoactive delirium, while 64% of ICU patients had agitated delirium (P < 0.0001). Persistent delirium at hospital discharge was more common among ward patients (66% vs 17%, P < 0.0001). On multivariable analysis, age and dementia predicted persistent delirium, while surgery predicted recovery.ConclusionsDelirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection and goals of care should be adapted to the environment in which it occurs.© 2019 Royal Australasian College of Physicians.

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