Monday, February 23, 2009

Prognosis of persistent delirium

It seems that 'persistent delirium' is becoming an increasingly investigated syndrome (see recent post on this here).

JAGS has another paper about the natural history of persistent delirium. The study uses data from a prospective delirium abatement trial and looks specifically at patients (n=412 for this analysis, mean age 84 years, ~38% with baseline dementia) discharged from hospitals to other care facilities (basically nursing homes/subacute facilities). All subjects in this analysis were discharged to a facility with delirium. 1 year overall mortality was 39%. Of those alive at 6 months, one-third still had persistent delirium (it's unclear to me how this was actually defined in the study but these patients at the very least had persistent cognitive impairments which did not exist prior to the index hospitalization). Persistent delirium was an independent risk factor for death, and the survival curves converged significantly for those patients whose delirium resolves vs. those who didn't. Again, the overall 1-year mortality was a dismal 39%, and still about 1-in-3 patients whose delirium actually resolved had died by the end of the year: persistent delirium is a very poor prognostic sign.

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