The Analyzes of Delirium Cases Presenting to the Emergency Department

Abstract

Study Objectives: The aim of this study is to analyze the predisposing factors and comorbid conditions in patients presenting to the emergency department with the clinical features of delirium and review the management of these patients.
Methods: The predisposing factors in patients with the clinical features of delirium presenting to the emergency department during day time between May 2003 and May 2004 were prospectively analyzed. Delirium is diagnosed with the criteria stated in the third revision of “Diagnostic and Statistical Manual of Mental Disorders”. Besides the physical findings and routine laboratory analyses, ABG, ECG, radiological analyses, and where appropriate EEG and cranial CT were ordered to determine the predisposing factors in delirium. The comorbid conditions, pulmonary and cardiac disorders, systemic infections, fever, fluid and electrolyte abnormalities were also considered. Patients with severe dementia and psychiatric disorders were excluded from the study.
Results: During the study period, 78 patients between the ages of 19 and 92 (mean age: 61±11) presented to the emergency department with the clinical findings of delirium. Thirty-two of them were female. 37.1% of patients were hyperactive type, 38.4% were hypoactive type and 24.3% were unidentified (mixt) type. The causes of delirium were drug overdoses (16%), stroke (11.5%), hyponatremia (8.9%), and hypertensive encephalopathy (6.4%). As hyperactive delirium were determined in patients with hypertensive encephalopathy and hypoglycemia, hypoactive delirium findings were determined in patients with stroke, hyponatremia, intracranial mass lesions, and infectious conditions. Despite all studies performed during the patients were in the emergency department, the cause of the delirium were not determined in 5 (6.4%).
Conclusions: Delirium is a complex clinical condition results from severe disorders. Emergency physicians should be familiar with the principles of the management of patients with delirium. Appropriate management is so important for the therapy of these patients.