Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

<p><b>INTRODUCTION</b>The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.</p><p><b>METHODS</b>A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.</p><p><b>RESULTS</b>A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.</p><p><b>CONCLUSION</b>The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.</p>

Ideação suicida em pacientes internados em enfermarias de clínica médica: prevalência e sintomas depressivos / Suicidal ideation in patients admitted to general medical wards: prevalence and associated depressive symptoms

OBJETIVO: Verificar a frequência de ideação suicida e os sintomas depressivos associados a ela nos pacientes internados em enfermarias de clínica médica. MÉTODOS: Todos os adultos consecutivamente admitidos nas enfermarias de clínica médica de um hospital universitário foram randomizados e avaliados durante a primeira semana de internação. Coletaram-se dados sociodemográficos e aplicaram-se: o Patient Health Questionnaire (a pergunta sobre ideação suicida), o Inventário Beck de Depressão e o índice Charlson de comorbidade física. Utilizaram-se os testes t de Student, do qui-quadrado e a regressão logística. RESULTADOS: Dos 1.092 sujeitos, 79 (7,2%) apresentaram ideação suicida. Na análise multivariada, foram capazes de discriminar esses pacientes, após controlar para sexo, idade, comorbidade física e presença de uma síndrome depressiva, os seguintes sintomas, quando presentes em intensidade moderada a grave: tristeza [RR: 3,18; IC 95% = 1,78-5,65; p < 0,001], sensação de fracasso [RR: 2,01; IC 95% = 1,09-3,72; p = 0,03], perda do interesse nas pessoas [RR: 2,69; IC 95% = 1,47-4,94; p = 0,001] e insônia [RR: 1,74; IC 95% = 1,05-2,89; p = 0,03]. CONCLUSÃO: Os pacientes internados no hospital geral em enfermarias clínicas apresentaram prevalência de 7,2% de ideação suicida. Alguns sintomas, quando presentes em intensidade moderada a grave, deveriam alertar ao clínico-geral para investigar a presença de ideação suicida: tristeza, sensação de fracasso, perda do interesse nas pessoas e insônia.

OBJECTIVE: To assess the prevalence of suicidal ideation and the depressive symptoms associated to it in medical inpatients. METHODS: All adults consecutively admitted to the medical wards of a University Hospital had their names recorded, were randomized and evaluated during the first week of admission. Socio-demographic data were collected and the Patient Health Questionnaire (question 9, assessing suicidal ideation), the Beck Depression Inventory and the Charlson comorbidity index were applied. The Student t test, chi-square test and logistic regression analysis were used. RESULTS: Of the 1,092 patients who composed the sample, 79 (7.2%) reported having suicidal ideation. In the multivariate analysis, after adjusting for gender, age, physical comorbidity and the presence of a depressive syndrome, the following symptoms when in moderate to severe degree discriminated patients who had suicidal ideation: sadness [RR: 3.18; CI 95% = 1.78-5.65; p < 0.001], feeling like a failure [RR: 2.01; CI 95% = 1.09-3.72; p = 0.03], loss of interest in people [RR: 2.69; CI 95% = 1.47-4.94; p = 0.001] and insomnia [RR: 1.74; CI 95% = 1.05-2.89; p = 0.03]. CONCLUSION: The prevalence of suicidal ideation in medical inpatients was 7.2%. When present in a moderate to severe degree, symptoms like sadness, feeling like a failure, loss of interest in people and insomnia should alert the medical team to assess suicidal ideation.

Fatal nosocomial infection in medical wards of a University Hospital.

Nosocomial infection is one of the most common morbidity among hospitalized patients. While study dealing with epidemiologic pattern of those in living patients are numerous, studies focusing on patients who died of them are few. In this prevalence study, we found that patients having fatal nosocomial infections presented some distinguishable features. From May 1982 to December 1983, 109 out of 300 cases had fatal nosocomial infections (36.3%). There was a total of 168 episodes of infection in these patients (1.5 episodes per patient). The ages ranged from 13-91 years and both sexes were equally affected. Septicemia was the most common infection related directly to death (a causal relationship). Pneumonia was commonly contributing to death while urinary tract infection was the most common infection not related to death. Most patients had either rapidly fatal or ultimately fatal underlying diseases. The infections disease episodes in both types of underlying diseases were not significantly different. There was a bimodal age group distribution of those who died of infections (30 and 60 years). The peak survival was rather short (mode of 20.0 days) and the fatal infection occurred early in the hospitalized course (mode of 5.0 days). These data suggested that the prevalence of fatal nosocomial infection was high severe infection occurred early and types of infection may be a predictor of fatal outcome,. Any intervention focusing on prevention of severe infection, such as septicemia and pneumonia, should be encouraging.