Delirium natural history, complications and prognosis: Difference between revisions
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{{Delirium}} | {{Delirium}} | ||
{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com] | {{CMG}}; {{AE}} {{Sara.Zand}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com] | ||
==Overview== | ==Overview== | ||
The duration of [[delirium]] may vary from hours to months. After remission , [[delirium]] may increase the risk of functional decline, [[cognitive dysfunction]], and [[institutional placement]], and with higher [[mortality]]. [[Delirium]] in the elderly, can cause many complications, which may include [[pneumonia]] and [[decubitus ulcers]], prolonging [[hospital]] stays. [[Delirium]] was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after [[orthopedic]] surgery. Common complications associated with [[delirium]] include increased [[mortality]], [[cognitive impairment]], longer durations of [[mechanical ventilation]], longer lengths of stay in the [[ICU]]. Prognosis is dependent on the severity of [[delirium]], and the 1 year [[mortality rate]] of [[patients]] with [[delirium]] is approximately 10%-26%. | |||
==History== | ==History== | ||
*The duration of [[delirium]] is typically affected by the underlying cause. | |||
The duration of delirium is typically affected by the underlying cause. If caused by a fever, the delirious state often subsides as the severity of the fever subsides. | * If caused by a [[fever]], the [[delirious]] state often subsides as the severity of the [[fever]] subsides. | ||
* Ranges from less than a week to more than 2 months. | * Ranges from less than a week to more than 2 months. | ||
* Most of the | * Most of the time [[symptoms]] resolve by 10 to 12 days. | ||
* Up to 15% of patients, typically elderly, | * Up to 15% of [[patients]], typically [[elderly]], [[delirium ]] may last for a month and beyond. | ||
* [[Delirium]] associated with substance withdrawal develops when concentrations of the substance in [[fluid]] and [[tissue]] decrease. | |||
==Complications and Prognosis== | ==Complications and Prognosis== | ||
* | * The duration of [[delirium]] may vary from hours to months.<ref name="RudbergPompei1997">{{cite journal|last1=Rudberg|first1=Mark A|last2=Pompei|first2=Peter|last3=Foreman|first3=Marquis D.|last4=Ross|first4=Ruth E.|last5=Cassel|first5=Christine K.|title=The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity|journal=Age and Ageing|volume=26|issue=3|year=1997|pages=169–174|issn=0002-0729|doi=10.1093/ageing/26.3.169}}</ref> | ||
* | * After remission , [[delirium]] may increase the risk of functional decline, [[cognitive dysfunction]], and [[institutional placement]], and with higher [[mortality]].<ref name="McNicollPisani2003">{{cite journal|last1=McNicoll|first1=Lynn|last2=Pisani|first2=Margaret A.|last3=Zhang|first3=Ying|last4=Ely|first4=E. Wesley|last5=Siegel|first5=Mark D.|last6=Inouye|first6=Sharon K.|title=Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients|journal=Journal of the American Geriatrics Society|volume=51|issue=5|year=2003|pages=591–598|issn=00028614|doi=10.1034/j.1600-0579.2003.00201.x}}</ref> | ||
* [[Delirium]] in the elderly, can cause many complications, which may include [[pneumonia]] and [[decubitus ulcers]], prolonging [[hospital]] stays. | |||
* Delirium in | * Up to 25% of patients with [[delirium ]] die within 6 months and that their [[mortality]] rate in the 3 months after diagnosis is 14 times as high as the [[mortality]] rate for [[patients]] with affective disorders. | ||
*After one episode of [[delirium]], the mortality rate was 24%-76% within one year.<ref name="McCuskerCole2003">{{cite journal|last1=McCusker|first1=Jane|last2=Cole|first2=Martin|last3=Dendukuri|first3=Nandini|last4=Han|first4=Ling|last5=Belzile|first5=Éric|title=The course of delirium in older medical inpatients|journal=Journal of General Internal Medicine|volume=18|issue=9|year=2003|pages=696–704|issn=0884-8734|doi=10.1046/j.1525-1497.2003.20602.x}}</ref> | |||
* [[Delirium]] was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after [[orthopedic]] surgery.<ref name="www.ncbi.nlm.nih.gov">{{Cite web | last = | first = | title = Practice guideline for the treatment of pati... [Am J Psychiatry. 1999] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/10327941 | publisher = | date = | accessdate = }}</ref> | |||
*Common complications associated with [[delirium]] include increased [[mortality]], [[cognitive impairment]], longer durations of [[mechanical ventilation]], longer lengths of stay in the [[ICU]].<ref name="SalluhWang2015">{{cite journal|last1=Salluh|first1=J. I. F.|last2=Wang|first2=H.|last3=Schneider|first3=E. B.|last4=Nagaraja|first4=N.|last5=Yenokyan|first5=G.|last6=Damluji|first6=A.|last7=Serafim|first7=R. B.|last8=Stevens|first8=R. D.|title=Outcome of delirium in critically ill patients: systematic review and meta-analysis|journal=BMJ|volume=350|issue=may19 3|year=2015|pages=h2538–h2538|issn=1756-1833|doi=10.1136/bmj.h2538}}</ref> | |||
*Prognosis is dependent on the severity of [[delirium]], and the 1 year [[mortality rate]] of [[patients]] with [[delirium]] is approximately 10%-26%.<ref name="pmid11863480">{{cite journal |vauthors=McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E |title=Delirium predicts 12-month mortality |journal=Arch Intern Med |volume=162 |issue=4 |pages=457–63 |date=February 2002 |pmid=11863480 |doi=10.1001/archinte.162.4.457 |url=}}</ref> | |||
* Up to 25% of patients with delirium die within 6 months and that their mortality rate in the 3 months after diagnosis is 14 times as high as the mortality rate for patients with affective disorders. | |||
* | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 11:37, 22 April 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]
Overview
The duration of delirium may vary from hours to months. After remission , delirium may increase the risk of functional decline, cognitive dysfunction, and institutional placement, and with higher mortality. Delirium in the elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays. Delirium was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after orthopedic surgery. Common complications associated with delirium include increased mortality, cognitive impairment, longer durations of mechanical ventilation, longer lengths of stay in the ICU. Prognosis is dependent on the severity of delirium, and the 1 year mortality rate of patients with delirium is approximately 10%-26%.
History
- The duration of delirium is typically affected by the underlying cause.
- If caused by a fever, the delirious state often subsides as the severity of the fever subsides.
- Ranges from less than a week to more than 2 months.
- Most of the time symptoms resolve by 10 to 12 days.
- Up to 15% of patients, typically elderly, delirium may last for a month and beyond.
- Delirium associated with substance withdrawal develops when concentrations of the substance in fluid and tissue decrease.
Complications and Prognosis
- The duration of delirium may vary from hours to months.[1]
- After remission , delirium may increase the risk of functional decline, cognitive dysfunction, and institutional placement, and with higher mortality.[2]
- Delirium in the elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
- Up to 25% of patients with delirium die within 6 months and that their mortality rate in the 3 months after diagnosis is 14 times as high as the mortality rate for patients with affective disorders.
- After one episode of delirium, the mortality rate was 24%-76% within one year.[3]
- Delirium was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after orthopedic surgery.[4]
- Common complications associated with delirium include increased mortality, cognitive impairment, longer durations of mechanical ventilation, longer lengths of stay in the ICU.[5]
- Prognosis is dependent on the severity of delirium, and the 1 year mortality rate of patients with delirium is approximately 10%-26%.[6]
References
- ↑ Rudberg, Mark A; Pompei, Peter; Foreman, Marquis D.; Ross, Ruth E.; Cassel, Christine K. (1997). "The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity". Age and Ageing. 26 (3): 169–174. doi:10.1093/ageing/26.3.169. ISSN 0002-0729.
- ↑ McNicoll, Lynn; Pisani, Margaret A.; Zhang, Ying; Ely, E. Wesley; Siegel, Mark D.; Inouye, Sharon K. (2003). "Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients". Journal of the American Geriatrics Society. 51 (5): 591–598. doi:10.1034/j.1600-0579.2003.00201.x. ISSN 0002-8614.
- ↑ McCusker, Jane; Cole, Martin; Dendukuri, Nandini; Han, Ling; Belzile, Éric (2003). "The course of delirium in older medical inpatients". Journal of General Internal Medicine. 18 (9): 696–704. doi:10.1046/j.1525-1497.2003.20602.x. ISSN 0884-8734.
- ↑ "Practice guideline for the treatment of pati... [Am J Psychiatry. 1999] - PubMed - NCBI".
- ↑ Salluh, J. I. F.; Wang, H.; Schneider, E. B.; Nagaraja, N.; Yenokyan, G.; Damluji, A.; Serafim, R. B.; Stevens, R. D. (2015). "Outcome of delirium in critically ill patients: systematic review and meta-analysis". BMJ. 350 (may19 3): h2538–h2538. doi:10.1136/bmj.h2538. ISSN 1756-1833.
- ↑ McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E (February 2002). "Delirium predicts 12-month mortality". Arch Intern Med. 162 (4): 457–63. doi:10.1001/archinte.162.4.457. PMID 11863480.