Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: a prospective cohort study.

PURPOSE: We aimed to study the use of The 4 'A's test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. METHODS: In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. RESULTS: Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). Out of the 100 patients with sepsis, 68 (68%) had delirium during the hospital stay, as compared to 34 out of 96 patients (35%) without sepsis (p < 0.05). CONCLUSION: Delirium screening upon ED admission, using 4AT, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. The prevalence of delirium during the hospital stay was high, particularly in patients with sepsis. Delirium screening with 4AT in the Emergency Department.

Pain and bleeding associated with trephine biopsy.

The study objectives were to determine the intensity and duration of pain, factors that may influence pain experience during and after trephine biopsy, and to assess bleeding and infectious complications related to the procedure. Patients scheduled for trephine biopsy were recruited to the study. Local anesthesia was applied in all patients. Pain intensity was recorded twice daily by the patients using the numeric rating scale (NRS). Bleeding was graded into four grades. Median age of 184 patients was 63 yr. Maximum NRS level was measured at time of biopsy (T0); 167 (91%) patients experienced pain at T0. Median (Q1:Q3) NRS was 3 (1; 5). Median duration of pain was 36 h. Fourteen patients reported pain for more than 7 d. Significant inverse correlation was found between NRS at T0 and age. Pain duration at rest correlated with NRS at T0 and age, while pain duration in activity correlated with NRS at T0, age, and with body mass index (BMI). Mild and moderate bleeding at T0 occurred in 97 (54%) and 18 (10%) patients, respectively; no severe bleeding or infectious complications were registered. Secondary bleeding occurred in two patients; both required hospitalization. In conclusion, the study shows that despite the application of local anesthetic, more than 50% of the patients experienced pain of ≥ 3 points. Procedure-related bleeding is mild to moderate and managed by local pressure only.