Hyperactive delirium during emergency department stay: analysis of risk factors and association with short-term outcomes
Authors: Miró Òscar , Osorio Gina , Alquézar-Arbé Aitor , Aguiló Sira , Fernández Cesáreo , Burillo Guillermo , Jacob Javier , Llorens Pere , Llauger Lluís , Peláez González Ángel , Figuera Castro Edmundo Ramón , Juarez González Ricardo , Blanco Hoffman María José , Fernandez Salgado Fátima , Pablos Pizarro Teresa , Berenguer Díez María Amparo , Truyol Más Marina , López-Laguna Nieves , Garcia Acosta Jacinto , Fernandez Domato Carmen , Diego Robledo Francisco Javier , Ezponda Patxi , Martinez Lorenzo Andrea , Ortega Liarte Juan Vicente , García Rupérez Inmaculada , Borne Jerez Setefilla , Corugedo Ovies Claudia , Gallardo Sánchez Blanca Andrea , Del Castillo Juan González ,   the researchers of the SIESTA network, González Del Castillo Juan , Fernandez Alonso Cesáreo , Garcia Lamberechts Jorge , Chacon García Ana , Queizan García Paula , Peirago Bravo Andrea , Melcon Villalibre Alejandro , Vargas Lobé Sara , Güemes de la Iglesia Cristina , Honrado Galán Beatriz , Moreno Ruíz Sandra , Troiano Ungerer Osvaldo Jorge , Martin Mojarro Enrique , Burillo Putze Guillermo , Vaswani Bulchand Aarati , Eiroa Hernández Patricia , Parra Esquivel Patricia , Piñera Salmerón Pascual , García Rosa Inés , Quesada Martínez María Consuelo , Gómez Gómez Marta Isabel , Reverte Pagán Yurena , Gantes Nieto Patricia , Arroyo Linares Virginia , Rodrigo González Sara , Jiménez Sònia , Aguiló Mir Sira , Alemany González Francesc Xavier , Poblete Palacios María Florencia , Amarilla Molinas Claudia Lorena , Osorio Gina , Cuerpo Cardeñosa Sandra , González Tejera Matilde , Puche Alcaraz Ana , Chacón García Cristina , Serrano Lázaro Leticia , Millán Soria Javier , Mansilla Collado Jésica , Bóveda García María , Llorens Soriano Pere , Gil Rodrigo Adriana , Espinosa Fernández Begoña , Veguillas Benito Mónica , Guzmán Martínez Sergio , Jara Torres Gema , Caballero Martínez María , Jacob Rodríguez Javier , Llopis Ferran , Fuentes Elena , Fuentes Lidia , Chamorro Francisco , Guillen Lara , López Nieves , Suero Méndez Coral , Zambrano Serrano Lucía , Muñoz Martos Rocío , Salido Mota Manuel , Toro Gallardo Valle , Real López Antonio , Ocaña Martínez Lucía , Muñoz Soler Esther , Lozano Sánchez Mario , Fraguero Blesa Eva , Chaib Fahd Beddar , Gil Hernández Rodrigo Javier , Pedraza García Jorge , Pedraza Ramírez Paula , Montero-Pérez Francisco Javier , Lucena Aguilera Carmen , Quero Espinosa Francisco de Borja , Cobos Requena Ángela , Muñoz Triano Esperanza , Bajo Fernández Inmaculada , Calderón Caro María , Bretones Baena Sierra , Miguens Blanco Iria , Muñoz Betegón Ioana , Micheloud Giménez Dariela Edith , Sánchez-Tembleque Sanchez Jorge , Macías Bou Belén , Díez Romero Paloma , Fernández Cardona María , Andrés Berián Leonor , González Ferreira Lucía , Hernando González Rocio , Rodríguez Palma María Eugenia , Varona Castrillo Javier , Aguilar Pérez Daniel , Álvarez Madrigal Alberto , Iglesias Vela Marta , Santos Orús Mónica , Chávez Flores Rudiger Carlos , Moreno Martín Miguel , Carbó Jordá Albert , González Revuelta Enrique , Sánchez Aroca Sara , Antonio Pérez-Costa Rafael , Rodríguez Romero María , Marín Arranz Esperanza , Ramírez Gallardo Elena , Palací Bataller Ana , Sánchez Herrero Paula , Martínez-Ibarreta Zorita Julia , Cabrera Rodrigo Irene , Mañero Criado Beatriz , Torres Gárate Raquel , González González Rebeca , Quero Motto Eva , Tomas Garcia Nuria , Bernal Martínez Laura , Carrión Fernández Marina , Escudero Sánchez Carmen , Morales Franco Belén , Adroher Muñoz Maria , Soy Ferrer Ester , Poch Ferrer Eduard Anton , Hong Cho Jeong-Uh , Trent Español Patricia , López López Fernando , Navarro Calzada Jorge , Gros Bañeres Belén , Martín Durán Cristina , Escolar Martínez-Berganza María Teresa , González Salvatierra Iciar , Gayoso Martín Sara , Sánchez Sindín María Goretti , Fernández Álvarez María Esther , Silva Penas Martina , Puiggali Ballard Margarita , Petrus Rivas Maria Carmen , Gómez Gómez Bárbara , Cirera Lorenzo Isabel , Alquezar Arbé Aitor , Borrego Yanes Isel , Doi Grande Adriana Laura , Herrera Mateo Sergio , Trejo Gutiérrez Olga , Ponte Márquez Paola , Romero Carrete Carlos , Francesena González Sayoa , Rodríguez Valles Celia , Vázquez Rey Verónica , Rodríguez Mejía Antonio , Carrasco Fernández Elena , Cañete Mónica , Sousa Mar , Molina Laura , Ruescas Esther , Ruiz Asensio Pedro , Martínez Juan María , Paderne Díaz Beatriz , De las Nieves Rodríguez Eva , Gómez García Gema , Fernández-Simón Almela Amparo , Pérez García Esther , Rivas Del Valle Pedro , Sánchez Moreno María , Rios Gallardo Rafaela , Redondo Lora Laura , Gómez Caminero Ana , Bueno Mariscal Claudio , Berenguer Diez María Amparo , De Juan Gómez María Ángeles , López Grima María Luisa , Del Rio Navarro Rigoberto Jesús , Rull Bertrán Pere , Masid Barcon Marta , Granado Fronzo Fiorella , Perelló Viola Núria , Hernández-Castells Lourdes , Noceda José Bermejo , Sánchez Moreno María Teresa , Benavent Campos Raquel , Cortés Soler Alejandro , Maza Vera María Teresa , Rodríguez Calveiro Raquel , Balado Dacosta Paz , Delgado Sardina Violeta , González Nespereira Emma , Sánchez Fernández-Linares Elena , García García Ángel , Palomero Martín Manuel Ángel , Sánchez Serrano Jesús Ángel , Soriano Pérez María Jesús , Oliva Ramos José Ramón , Carbajosa Rodríguez Virginia , Sánchez Ramón Susana , Marchena Maria José , Santos Martin Jose Maria , Santianes Patiño Jesús , Gutiérrez Alcalá Octavio , Herrero Puente Pablo , Martínez Alonso Alba , López Carrillo Ángela , Pérez Fernández Belén , Pérez Fonseca Carmen 
Published: October 2023

To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24–4.82), transfer to the ED observation unit (1.62, 1.23–2.15), chronic treatment with opiates (1.51, 1.09–2.09) and length of ED stay longer than 12 h (1.41, 1.02–1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37–0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83–2.78), need for hospitalization 25.6% and 25% (1.09, 0.83–1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24–4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80–2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82–2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.