Trigger-tools performance for screening potential hyperactive delirium in older people hospitalized in a Brazilian emergency department
Objective: Assess the performance of trigger-tools in detecting hospitalizations of older patients with potential hyperactive delirium in na emergency department. Methods: A cross-sectional study was performed with all patients aged ≥60 years old hospitalized in the emergency department of a Brazilian teaching hospital in 2018. The screening of potential hyperactive delirium was performed with the following trigger tools: prescription of intra-hospital antipsychotic medicines, codes of the 10th International Classification of Diseases (ICD-10) proposal by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, and trigger-words related to hyperactive delirium registered in medical records by health professionals. The positive predictive value (PPV) was calculated to assess the performance of each trigger tool. Results: Most hospitalizations (193/286) were screened by at least one trigger tool, of which 49.2% showed potential hyperactive delirium. ICD-10 trigger tool showed better performance (PPV= 0.71), although the strategy had underestimated the detection of potential cases [2.6% (5/193)]. Despite the performance of intra-hospital prescriptions of antipsychotic and trigger-words had been lower (PPV= 0.69, and PPV=0.48, respectively), the prevalence of potential hyperactive delirium identified were greater with these methods [30.0% (58/193); and 47.1% (91/193); respectively]. Conclusion: The use of trigger tools detected one out three hospitalizations of older people with potential hyperactive delirium. The combination of the strategies may contribut to the recognition of the syndrome in emergency department. Data suggests the screening may be performed by pharmacists in association with multicomponent and interprofessional approaches to improve patient safety.
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