Characterization of the adult patients' falling incidents in a university hospital. / Caracterização dos incidentes de quedas de pacientes adultos internados em um hospital universitário.

OBJECTIVE: To evaluate the occurrences and to characterize the falling incidents of adult patients hospitalized in clinical and surgical units of a university hospital in the southern region of the country, in the period from 2011 to 2014. METHOD: Descriptive, cross-sectional and retrospective study, carried out from December 2016 to December 2017. The sample consisted of 1112 reports, covering all hospitalized patients who were notified with falls occurring in the studied period. Data were analyzed using descriptive and analytical statistics. RESULTS: Female and elderly patients were predominant in the sample, in which 69.4% of the incidents did not present any damage. The occurrence of falls was significantly higher at night. Limitation to walking and being unaccompanied were the most prevalent factors in the patient's conditions before the fall. CONCLUSION: The fall is a multifactorial event that requires periodic evaluation of the risk factors by the team to plan their prevention.

Caracterização dos incidentes de quedas de pacientes adultos internados em um hospital universitário / Caracterización de los incidentes de caídas de pacientes adultos internados en un hospital universitario / Characterization of the adult patients' falling incidents in a university hospital

Resumo OBJETIVO Avaliar as notificações e caracterizar os incidentes de quedas dos pacientes adultos internados em unidades clínicas e cirúrgicas de um hospital universitário na região sul do país, no período de 2011 a 2014. MÉTODO Estudo descritivo, transversal e retrospectivo, realizado no período de dezembro de 2016 a dezembro de 2017. A amostra foi de 1112 notificações, abrangendo todos os pacientes internados que foram notificados com ocorrência de quedas no período estudado. Os dados foram analisados por meio de estatística descritiva e analítica. RESULTADOS Foram predominantes na amostra os pacientes do sexo feminino e idosos, onde 69,4% dos incidentes não apresentaram dano. A ocorrência de quedas foi significativamente maior no período noturno. Limitação para deambular e estar desacompanhado foram os fatores mais prevalentes nas condições do paciente antes da queda. CONCLUSÃO Queda é um evento multifatorial que necessita avaliação periódica dos fatores de risco pela equipe para planejar sua prevenção.

Resumen OBJETIVO Evaluar las notificaciones y caracterizar los incidentes de caídas de los pacientes adultos internados en unidades clínicas y quirúrgicas de un hospital universitario en la región sur del país, en el período 2011 a 2014. MÉTODO Estudio descriptivo, transversal y retrospectivo, realizado en el período de diciembre de 2016 a diciembre de 2017. La muestra fue de 1112 notificaciones, abarcando a todos los pacientes internados que fueron notificados con ocurrencia de caídas en el periodo estudado. Los datos fueron analizados por medio de estadística descriptiva y analítica. RESULTADOS: Fueron predominantes en la muestra los pacientes del sexo femenino y ancianos, donde el 69,4% de los incidentes no presentaron daño. La ocurrencia de caídas fue significativamente mayor en el período nocturno. La limitación para deambular y estar desatendido fueron los factores más prevalentes en las condiciones del paciente antes de la caída. CONCLUSIÓN La caída es un evento multifactorial que necesita evaluación periódica de los factores de riesgo por el equipo para planificar su prevención.

Abstract OBJECTIVE To evaluate the occurrences and to characterize the falling incidents of adult patients hospitalized in clinical and surgical units of a university hospital in the southern region of the country, in the period from 2011 to 2014. METHOD Descriptive, cross-sectional and retrospective study, carried out from December 2016 to December 2017. The sample consisted of 1112 reports, covering all hospitalized patients who were notified with falls occurring in the studied period. Data were analyzed using descriptive and analytical statistics. RESULTS Female and elderly patients were predominant in the sample, in which 69.4% of the incidents did not present any damage. The occurrence of falls was significantly higher at night. Limitation to walking and being unaccompanied were the most prevalent factors in the patient's conditions before the fall. CONCLUSION The fall is a multifactorial event that requires periodic evaluation of the risk factors by the team to plan their prevention.

Delirium during the first evaluation of children aged five to 14 years admitted to a paediatric critical care unit.

OBJECTIVES: To describe the prevalence and characteristics of delirium during the initial evaluation of critically ill patients aged 5-14 years. METHOD/DESIGN: This is a cross-sectional descriptive study in a critical care unit. For six months, all patients were evaluated within the first 24-72 hours or when sedation permitted the use of the paediatric confusion assessment method for the intensive care unit (PCAM-ICU) and the Delirium Rating Scale-Revised-98 items #7 and #8 to determine motor type. We report the characteristics of PCAM-ICU delirium (at least three of the required items scored positive) and of subthreshold score cases (two positive items). RESULTS: Of 77 admissions, 15 (19.5%) had delirium, and 11 (14.2%) were subthreshold. A total of 53.3% of delirium and 45.5% of subthreshold cases were hypoactive. The prevalence of delirium and subthreshold PCAM-ICU was 83.3% and 16.7% in mechanically ventilated children. The most frequent combination of PCAM-ICU alterations in subthreshold cases was acute onset-fluctuation with altered alertness. The main nursing diagnoses were related to reduced cellular respiration. CONCLUSIONS: Delirium is common in critically ill children. It is necessary to assess whether certain nursing diagnoses imply an increase in delirium. Longitudinal studies of subthreshold PCAM-ICU cases are needed to understand their importance better.

Confusion, agitation and delirium.

Delirium is one of the most serious and common complications that up to one third of older patients admitted to hospital develop. It is characterized by a disturbance of consciousness, decreased attention, and disorganized thinking that develops over a short period of time, and fluctuates during the course of the day. Delirium post-stroke prevalence ranges from 13 to 48% in general hospitals, and from 10.1 to 28% in Stroke Units. The Confusion Assessment Method and the Delirium Rating Scale are used as delirium screening tools. The cause of delirium is likely to be multifactorial. In stroke, reduced perfusion of the brain with hypoxia, which deranges neurotransmission, may be the cause. Delirium is more frequent after intracerebral hemorrhage and infarction in specific brain areas. Delirium without other signs of stroke has been reported more often after right-sided than after left-sided lesions. Age, cognitive decline, and multiple coexisting conditions are the most consistent and important risk factors for delirium post-stroke. Haloperidol is currently used as the drug of choice, if sedation is needed.

[Delirium in elderly inpatients. An 18 month follow-up]. / Delirium en ancianos hospitalizados. Seguimiento de 18 meses.

Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during hospital stay and the next 18 month follow-up. Patients aged 70 or older admitted to internal medicine unit between September 2005 and May 2006 were enrolled. Delirium was assessed with the Spanish version of Confusion Assessment Method. Demographic data, cause of admition and length of stay, destination after discharge and mortality were registered. A new evaluation was made 18 months after discharge. We evaluated 194 patients and 74 were excluded. Of the 120 included, 52 (43.3%) presented delirium. We found significant differences between patients with and without delirium in previous placement in nursing home (17.3% vs. 1.5%; p < 0.002), dementia (40.4% vs. 8.8%; p < 0.001), median activity of daily living (5 vs. 6; p < 0.001), length-of-stay (7 vs. 5; p = 0.04) and mortality rate (21.2% vs. 1.5%; p < 0.001). Evaluation 18 months later showed differences between patients with and without delirium in median of activity of daily living (1/6 vs. 5/6), patients living in nursing homes (27.5% vs. 7.9%), estimated survival 35.3% (CI 95%: 24-49%) at day 569 and 49% (CI 95%: 32.9-65.4%) at day 644. The difference between survival curves was statistically significant (p = 0.027). Delirium increases morbidity and mortality during hospital stay. Elderly with delirium are at risk of worsening disability and of becoming dependent after discharge and it is a risk factor for higher mortality during the following months after discharge.

Delirium en ancianos hospitalizados: Seguimiento de 18 meses / Delirium in elderly inpatients: An 18 month follow-up

El objetivo de este trabajo fue describir la prevalencia de síndrome confusional agudo en ancianos hospitalizados, la evolución durante la internación y a los 18 meses. Se evaluó en forma prospectiva a pacientes de 70 años de edad o mayores, internados en el Servicio de Clínica Médica de nuestro hospital, entre septiembre de 2005 y mayo de 2006. Se utilizó una versión validada en español del Confussion Assessment Method para diagnosticar delirium. A los 18 meses se evaluó el estado vital, lugar de residencia, actividades de la vida diaria, dependencia de cuidadores y reinternaciones. Se evaluaron 194 pacientes y 74 fueron excluidos. De los 120 casos incluidos, 52 (43.3%) presentaron delirium. La edad media fue de 82.6 años (DS: 7.4) en el grupo de pacientes con síndrome confusional agudo y de 80.4 años (DS: 5.6) en el grupo de pacientes sin delirium. Al comparar estos dos grupos encontramos diferencias significativas en las características, siendo más frecuentes en el grupo con delirium la residencia previa en un centro de tercer nivel (17.3% vs. 1.5%; p < 0.002), la demencia (40.4% vs. 8.8%; p < 0.001), menor puntaje en la evaluación de las actividades de la vida diaria (5 vs. 6; p < 0.001), más días de internación (7 vs. 5; p = 0.04) y mayor mortalidad intrahospitalaria (21.2% vs. 1.5%; p < 0.001). A los 18 meses de seguimiento después del alta, el desarrollo de delirium durante la internación se asoció a mayor grado de dependencia evidenciado por el peor puntaje en las actividades de la vida diaria (mediana 1/6 vs. 5/6) y a menor sobrevida actuarial 35.3% (CI 95%: 24-49%) a los 569 días y 49% (CI 95%: 32.9-65.4%) a los 644 días (p=0.027).

Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during hospital stay and the next 18 month follow-up. Patients aged 70 or older admitted to internal medicine unit between September 2005 and May 2006 were enrolled. Delirium was assessed with the Spanish version of Confusion Assessment Method. Demographic data, cause of admition and length of stay, destination after discharge and mortality were registered. A new evaluation was made 18 months after discharge. We evaluated 194 patients and 74 were excluded. Of the 120 included, 52 (43.3%) presented delirium. We found significant differences between patients with and without delirium in previous placement in nursing home (17.3% vs. 1.5%; p < 0.002), dementia (40.4% vs. 8.8%; p < 0.001), median activity of daily living (5 vs. 6; p < 0.001), length-of-stay (7 vs. 5; p = 0.04) and mortality rate (21.2% vs. 1.5%; p < 0.001). Evaluation 18 months later showed differences between patients with and without delirium in median of activity of daily living (1/6 vs. 5/6), patients living in nursing homes (27.5% vs. 7.9%), estimated survival 35.3% (CI 95%: 24-49%) at day 569 and 49% (CI 95%: 32.9-65.4%) at day 644. The difference between survival curves was statistically significant (p = 0.027). Delirium increases morbidity and mortality during hospital stay. Elderly with delirium are at risk of worsening disability and of becoming dependent after discharge and it is a risk factor for higher mortality during the following months after discharge.

ApoE epsilon4 is not associated with posictal confusion in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.

A previous report found an association between ApoE isoforms and postictal confusion in medically intractable temporal lobe epilepsy (TLE). We performed a molecular epidemiology study in an independent sample of 77 TLE patients. We failed to replicate the original allelic association between ApoE epsilon4 allele and postictal confusion in our population (chi(2)=1.67; d.f.=1; p=0.2). Thus, the association between ApoE epsilon4 allele and postictal confusion still needs to be fully investigated in different and independent populations.

[Acute confusion syndrome in the hospitalized elderly]. / Síndrome confusional agudo en el anciano internado.

Our purpose was to determine the in-hospital incidence of delirium among elderly patients, its relation to previous cognitive impairment and the time between admission and its development. We performed an observational study of follow-up in the internal medicine area of a university hospital. We included consecutively and prospectively every patient 70 years or older upon admission. Patients with delirium on admission were excluded, as also were those taking antipsychotic drugs, with severe language or audition impairment, or coming from other sites of internation. We subsequently eliminated patients whose follow-up had not ended by the time the study was concluded, and patients in whom psychosis was diagnosed. Clinical and laboratory data were collected, and patients were prospectively followed until discharge from the hospital, using the Confusion-Assessment-Method (CAM) for the diagnosis of delirium. We analyzed 61 patients of whom 13 developed delirium while hospitalized (in-hospital incidence: 21.31%--CI 95%: 11.03-31.59%). Patients with delirium had had lower scores on Mini Mental State upon admission (median 17 vs 22; p 0.001). During the first 4 days of hospitalization 58.3% of delirium cases occurred not modifying the duration of hospitalization (average: 10.22 days vs 14.38; p = NS). We conclude that the incidence of delirium is high among hospitalized elderly patients specially during the first days, and in those with previous cognitive impairment. We suggest that delirium could be an associated disorder in severe diseases among patients with previous cognitive damage.

Delirium en pacientes de una unidad de cuidados intermedios: estudio prospectivo / Prevalence of delirium in an intermediate care unit

Background: Delirium or acute confusional state is defined as an acute disturbance of consciousness and attention. Its prevalence among hospitalized patients fluctuates between 25 and 60 percent. Aim: To assess the prevalence and features of delirium in an intermediate care unit. Patients and methods: All patients admitted to intermediate care unit during a period of two months were assessed and followed. Delirium was assessed daily during the stay in the unit, using the Inouye Confusion Assessment Method. Delirium was classified as hyperactive if the patient required pharmacological or physical restraining methods. Results: Sixty four patients, 32 female, aged 19 to 90 years old were assessed. Forty one percent had delirium. Of these, delirium started after admission in 46 percent and was hyperactive in 35 percent. Cognitive disturbances were ascertained by the health care team in 69 percent of patients with delirium. Age over 70 years old and a history of dementia were defined as predisposing factors for delirium. Serum albumin was > 3.5 g/dl in 14 of 18 patients with and in 11 of 27 patients without delirium (p=0.04). The most frequent risk factors were systemic infections, metabolic disturbances and intracranial lesions. Physical restraining and neuroleptics were the most commonly used measures to deal with hyperactive patients. Conclusions: The prevalence of delirium found in this study is similar to that reported elsewhere, except for the high proportion of patients whose delirium started after admission