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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5527-5530, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019231

RESUMO

The incidence of delirium in intensive care units is high and associated with poor outcomes; therefore, its prediction is desirable to establish preventive treatments. This retrospective study proposes a novel approach for delirium prediction. We analyzed static and temporal data from 10,475 patients admitted to one of 15 intensive care units (ICUs) in Alberta, Canada between January 1, 2014 and June 30, 2016. We tested 168 different combinations of study design parameters and five different predictive models (logistic regression, support vector machines, random forests, adaptive boosting and neural networks). The area under the receiver operating characteristic curve (AUROC) ranged from 0.754 (CI 95% ± 0.018) to 0.852 (± 0.033), with sensitivity and specificity respectively ranging from 0.739 (CI 95% ± 0.047) to 0.840 (CI 95% ± 0.064), and 0.770 (CI 95% ± 0.030) to 0.865 (CI 95% ± 0.038). These results are similar to previous studies; however, our approach allows for continuous updates and short-term prediction horizons which might provide major advantages.


Assuntos
Delírio , Alberta , Delírio/diagnóstico , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 99(43): e22884, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120832

RESUMO

Delirium is a neuropsychiatric syndrome commonly encountered in critically ill patients, and systemic inflammation has been strongly implicated to underlie its pathophysiology. This study aimed to investigate the predictive value of the platelet-to-lymphocyte ratio (PLR) for delirium in the intensive care unit (ICU).In this retrospective observational study, we analyzed the clinical and laboratory data of 319 ICU patients from October 2016 to December 2017. Using the Locally Weighted Scatterplot Smoothing technique, a PLR knot was detected at a value of approximately 100. Logistic regression was used to investigate the association between the PLR and delirium.Of the 319 patients included in this study, 29 (9.1%) were diagnosed with delirium. In the delirium group, the duration of mechanical ventilation was significantly longer than that in the no-delirium group (40.2 ±â€Š65.5 vs. 19.9 ±â€Š26.5 hours, respectively; P < .001). A multiple logistic regression analysis showed that PLR > 100 (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.001-1.005), age (OR: 2.76, 95% CI: 1.110-6.861), and the ratio of arterial oxygen partial pressure to the inspired oxygen fraction (OR: 0.996, 95% CI: 0.992-0.999) were independent predictors of delirium.In our study, a high PLR value on ICU admission was associated with a higher incidence of delirium. Owing to easy calculability, the PLR could be a useful delirium predictive index in ICUs, thereby enabling early interventions to be implemented.


Assuntos
Plaquetas/citologia , Estado Terminal/psicologia , Delírio/sangue , Linfócitos/citologia , Idoso , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Estudos de Casos e Controles , China/epidemiologia , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/fisiopatologia , Feminino , Humanos , Incidência , Inflamação/metabolismo , Inflamação/patologia , Inalação/fisiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , Valor Preditivo dos Testes , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
3.
PLoS One ; 15(9): e0234801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877411

RESUMO

BACKGROUND: Significant improvements in clinical outcome can be achieved by implementing effective strategies to optimise pain management, reduce sedative exposure, and prevent and treat delirium in ICU patients. One important strategy is the monitoring of pain, agitation and delirium (PAD bundle). We hypothesised that there is no sufficient financial benefit to implement a monitoring strategy in a Diagnosis Related Group (DRG)-based reimbursement system, therefore we expected better clinical and decreased economic outcome for monitored patients. METHODS: This is a retrospective observational study using routinely collected data. We used univariate and multiple linear analysis, machine-learning analysis and a novel correlation statistic (maximal information coefficient) to explore the association between monitoring adherence and resulting clinical and economic outcome. For univariate analysis we split patients in an adherence achieved and an adherence non-achieved group. RESULTS: In total 1,323 adult patients from two campuses of a German tertiary medical centre, who spent at least one day in the ICU between admission and discharge between 1. January 2016 and 31. December 2016. Adherence to PAD monitoring was associated with shorter hospital LoS (e.g. pain monitoring 13 vs. 10 days; p<0.001), ICU LoS, duration of mechanical ventilation shown by univariate analysis. Despite the improved clinical outcome, adherence to PAD elements was associated with a decreased case mix per day and profit per day shown by univariate analysis. Multiple linear analysis did not confirm these results. PAD monitoring is important for clinical as well as economic outcome and predicted case mix better than severity of illness shown by machine learning analysis. CONCLUSION: Adherence to PAD bundles is also important for clinical as well as economic outcome. It is associated with improved clinical and worse economic outcome in comparison to non-adherence in univariate analysis but not confirmed by multiple linear analysis. TRIAL REGISTRATION: clinicaltrials.gov NCT02265263, Registered 15 October 2014.


Assuntos
Delírio/terapia , Hipnóticos e Sedativos/uso terapêutico , Manejo da Dor/métodos , Adulto , Idoso , Delírio/diagnóstico , Delírio/economia , Gerenciamento Clínico , Feminino , Humanos , Hipnóticos e Sedativos/economia , Unidades de Terapia Intensiva/economia , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/economia , Manejo da Dor/economia , Respiração Artificial/economia , Respiração Artificial/métodos , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(35): e21595, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871875

RESUMO

BACKGROUND: Delirium is a frequent form of acute brain dysfunction in mechanically ventilated patients. Screening tools have been developed to identify delirium, but it is unclear which tool is the most accurate. Therefore, we provide a protocol of systematic evaluation to assess the accuracy of delirium screening tools in mechanically ventilated patients. METHODS: PubMed, PsycINFO, EMBASE, and the Cochrane Library will be searched. Studies involving mechanically ventilated patients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders criteria as a reference standard will be included. We will use MetaDiSC and STATA 15.1 to analyze carefully when a network meta-analysis is allowed. RESULTS: This study will provide a high-quality synthesis to assess the accuracy of different screening methods in mechanically ventilated patients. CONCLUSION: The conclusion of our systematic review will provide evidence to judge which screening method is the best for mechanically ventilated patients.


Assuntos
Encéfalo/fisiopatologia , Delírio/etiologia , Programas de Rastreamento/métodos , Respiração Artificial/efeitos adversos , Delírio/diagnóstico , Delírio/prevenção & controle , Testes Diagnósticos de Rotina/estatística & dados numéricos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Metanálise em Rede
6.
PLoS One ; 15(8): e0237639, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813717

RESUMO

BACKGROUND: Risk prediction models allow clinicians to forecast which individuals are at a higher risk for developing a particular outcome. We developed and internally validated a delirium prediction model for incident delirium parameterized to patient ICU admission acuity. METHODS: This retrospective, observational, fourteen medical-surgical ICU cohort study evaluated consecutive delirium-free adults surviving hospital stay with ICU length of stay (LOS) greater than or equal to 24 hours with both an admission APACHE II score and an admission type (e.g., elective post-surgery, emergency post-surgery, non-surgical) in whom delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors included in the model were readily available in electric medical records. Least absolute shrinkage and selection operator logistic (LASSO) regression was used for model development. Discrimination was determined using area under the receiver operating characteristic curve (AUC). Internal validation was performed by cross-validation. Predictive performance was determined using measures of accuracy and clinical utility was assessed by decision-curve analysis. RESULTS: A total of 8,878 patients were included. Delirium incidence was 49.9% (n = 4,431). The delirium prediction model was parameterized to seven patient cohorts, admission type (3 cohorts) or mean quartile APACHE II score (4 cohorts). All parameterized cohort models were well calibrated. The AUC ranged from 0.67 to 0.78 (95% confidence intervals [CI] ranged from 0.63 to 0.79). Model accuracy varied across admission types; sensitivity ranged from 53.2% to 63.9% while specificity ranged from 69.0% to 74.6%. Across mean quartile APACHE II scores, sensitivity ranged from 58.2% to 59.7% while specificity ranged from 70.1% to 73.6%. The clinical utility of the parameterized cohort prediction model to predict and prevent incident delirium was greater than preventing incident delirium by treating all or none of the patients. CONCLUSIONS: Our results support external validation of a prediction model parameterized to patient ICU admission acuity to predict a patients' risk for ICU delirium. Classification of patients' risk for ICU delirium by admission acuity may allow for efficient initiation of prevention measures based on individual risk profiles.


Assuntos
Estado Terminal , Delírio/diagnóstico , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Adulto , Idoso , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Fatores de Risco
8.
J Stroke Cerebrovasc Dis ; 29(9): 105013, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807428

RESUMO

BACKGROUND: Higher rates of delirium have been reported among patients with acute stroke. However, poorly modifiable risk factors have been documented to date while sign and symptoms capable of early detecting its onset and outcomes in this specific population have been largely neglected. The aim of this study was to emerge nurses' clinical knowledge and experiences regarding post-stroke delirium (a) risk factors, (b) signs and symptoms of delirium onset, and (c) outcomes. METHOD: A qualitative study based upon focus groups have been performed on 2019 and here reported according to the COnsolidated criteria for REporting Qualitative research. A purposeful sample of 28 nurses was invited to participate in focus groups at two Italian hospitals, and 20 participated. A semi-structured question guide was developed; all focus groups were audio recorded and then transcribed verbatim. Two researchers independently analysed, coded and categorised the findings according to the main research question. A member checking with ten nurses was also performed to ensure rigour. RESULTS: Four risk factors emerged (a) at the individual level; (b) associated with previous (e.g., dementia) and the current clinical condition (stroke), (c) associated with the nursing care delivered, and (d) associated with the hospital environment. In their daily practice, nurses suspect the onset of delirium when some motor, verbal or multidimensional signs and symptoms occur. The delirium episodes affect outcomes at the individual, family, and at the system levels. CONCLUSIONS: In a field of research in need of study, we have involved expert nurses who shared their tacit knowledge to gain insights regarding risk factors, early signs and symptoms of delirium and its outcomes to address future directions of this research field.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Delírio/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Acidente Vascular Cerebral/enfermagem , Adulto , Delírio/diagnóstico , Delírio/etiologia , Delírio/psicologia , Feminino , Humanos , Entrevistas como Assunto , Itália , Masculino , Pessoa de Meia-Idade , Prognóstico , Pesquisa Qualitativa , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia
9.
Br J Anaesth ; 125(1): 55-66, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499013

RESUMO

BACKGROUND: Delirium frequently affects older patients, increasing morbidity and mortality; however, the pathogenesis is poorly understood. Herein, we tested the cognitive disintegration model, which proposes that a breakdown in frontoparietal connectivity, provoked by increased slow-wave activity (SWA), causes delirium. METHODS: We recruited 70 surgical patients to have preoperative and postoperative cognitive testing, EEG, blood biomarkers, and preoperative MRI. To provide evidence for causality, any putative mechanism had to differentiate on the diagnosis of delirium; change proportionally to delirium severity; and correlate with a known precipitant for delirium, inflammation. Analyses were adjusted for multiple corrections (MCs) where appropriate. RESULTS: In the preoperative period, subjects who subsequently incurred postoperative delirium had higher alpha power, increased alpha band connectivity (MC P<0.05), but impaired structural connectivity (increased radial diffusivity; MC P<0.05) on diffusion tensor imaging. These connectivity effects were correlated (r2=0.491; P=0.0012). Postoperatively, local SWA over frontal cortex was insufficient to cause delirium. Rather, delirium was associated with increased SWA involving occipitoparietal and frontal cortex, with an accompanying breakdown in functional connectivity. Changes in connectivity correlated with SWA (r2=0.257; P<0.0001), delirium severity rating (r2=0.195; P<0.001), interleukin 10 (r2=0.152; P=0.008), and monocyte chemoattractant protein 1 (r2=0.253; P<0.001). CONCLUSIONS: Whilst frontal SWA occurs in all postoperative patients, delirium results when SWA progresses to involve posterior brain regions, with an associated reduction in connectivity in most subjects. Modifying SWA and connectivity may offer a novel therapeutic approach for delirium. CLINICAL TRIAL REGISTRATION: NCT03124303, NCT02926417.


Assuntos
Encéfalo/fisiopatologia , Delírio/diagnóstico , Delírio/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Citocinas/sangue , Delírio/sangue , Imagem de Tensor de Difusão/métodos , Eletroencefalografia/métodos , Humanos , Complicações Pós-Operatórias/sangue
10.
Ideggyogy Sz ; 73(05-06): 189-197, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579309

RESUMO

Background and purpose: Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. Methods: This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. Results: A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Conclusion: Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.


Assuntos
Unidades de Cuidados Coronarianos , Delírio/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Delírio/diagnóstico , Delírio/epidemiologia , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
13.
Ned Tijdschr Geneeskd ; 1642020 Apr 08.
Artigo em Holandês | MEDLINE | ID: covidwho-256224

RESUMO

Clinical characteristics and outcomes among older patients with a SARS-CoV-2 infection differ greatly from those seen in younger patients. Here we highlight atypical presentations of this fulminant infectious disease COVID-19, based on a clinical case and a cohort of 19 patients admitted to a geriatric ward. The degree of frailty, resilience and number of co-morbidities caused COVID-19 to present as acute geriatric syndrome events such as falls, delirium and dehydration in these patients. Clinical laboratory results considered typical for COVID-19 were present less often in this frail older population. As in other countries, morbidity and mortality is most severe among frail male patients; therefore, assessment of changes suggestive of typical acute geriatric syndromes in frail older patients with chronic diseases should lead to a careful clinical examination for a SARS-CoV-2 infection. Protocols for diagnosis, and contact isolation measures, should take these atypical presentations into account.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Delírio/diagnóstico , Diarreia/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Pandemias
14.
Ned Tijdschr Geneeskd ; 1642020 Apr 08.
Artigo em Holandês | MEDLINE | ID: mdl-32395966

RESUMO

Clinical characteristics and outcomes among older patients with a SARS-CoV-2 infection differ greatly from those seen in younger patients. Here we highlight atypical presentations of this fulminant infectious disease COVID-19, based on a clinical case and a cohort of 19 patients admitted to a geriatric ward. The degree of frailty, resilience and number of co-morbidities caused COVID-19 to present as acute geriatric syndrome events such as falls, delirium and dehydration in these patients. Clinical laboratory results considered typical for COVID-19 were present less often in this frail older population. As in other countries, morbidity and mortality is most severe among frail male patients; therefore, assessment of changes suggestive of typical acute geriatric syndromes in frail older patients with chronic diseases should lead to a careful clinical examination for a SARS-CoV-2 infection. Protocols for diagnosis, and contact isolation measures, should take these atypical presentations into account.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Delírio/diagnóstico , Diarreia/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Pandemias
15.
Anesth Analg ; 130(6): 1524-1533, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384342

RESUMO

Anesthetists are increasingly faced with the challenge of delivering perioperative care to frail older people. Patients with frailty undergoing surgical intervention are at a significantly increased risk of perioperative complications, mortality, and longer length of stay. Moreover, frailty is often associated with multimorbidity and a range of geriatric syndromes including functional dependency, cognitive impairment, and malnutrition which further increases risk and complexity of care. There is a growing body of evidence that prehabilitation-intervention delivered during the preoperative period to improve overall health and function-can improve postoperative outcomes for patients undergoing surgery. However, whether this vulnerable population stand to benefit from prehabilitation is less clear. We review the evidence for prehabilitation for patients with frailty including whether the risks associated with and outcomes from surgery can be modified through comprehensive geriatric assessment.


Assuntos
Delírio/prevenção & controle , Fragilidade/cirurgia , Avaliação Geriátrica/métodos , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Idoso , Disfunção Cognitiva/complicações , Delírio/diagnóstico , Idoso Fragilizado , Fragilidade/terapia , Humanos , Tempo de Internação , Desnutrição/complicações , Multimorbidade , Complicações Cognitivas Pós-Operatórias/diagnóstico , Período Pós-Operatório , Cuidados Pré-Operatórios , Fatores de Risco , Resultado do Tratamento , Populações Vulneráveis
17.
Anaesthesiol Intensive Ther ; 52(2): 132-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32419438

RESUMO

In March 2020, the World Health Organisation announced the COVID-19 pandemic caused by the SARS-CoV-2 virus. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement, including delirium occurring in critically ill patients (ICU delirium). Due attention must be paid to this subject in the face of the COVID-19 pandemic. Delirium, the detection of which takes less than two minutes, is frequently underestimated during daily routine ICU care, but it may be a prodromal symptom of infection or hypoxia associated with severe respiratory failure. During the COVID-19 pandemic, systematic delirium monitoring using validated tests (CAM-ICU or ICDSC) may be sacrificed. This is likely to be due to the fact that the main emphasis is placed on organisational issues, i.e. the lack of ventilators, setting priorities for limited mechanical ventilation options, and a shortage of personal protective equipment. Early identification of patients with delirium is critical in patients with COVID-19 because the occurrence of delirium may be an early symptom of worsening respiratory failure or of infectious spread to the CNS mediated by potential neuroinvasive mechanisms of the coronavirus. The purpose of this review is to identify problems related to the development of delirium during the COVID-19 epidemic, which are presented in three areas: i) factors contributing to delirium in COVID-19, ii) potential pathophysiological factors of delirium in COVID-19, and iii) long-term consequences of delirium in COVID-19. This article discusses how healthcare workers can reduce the burden of delirium by identifying potential risk factors and difficulties during challenges associated with SARS-CoV-2 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Delírio/etiologia , Unidades de Terapia Intensiva , Pneumonia Viral/complicações , Delírio/diagnóstico , Delírio/prevenção & controle , Delírio/psicologia , Humanos , Pandemias
18.
Med Klin Intensivmed Notfmed ; 115(5): 428-436, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32248245

RESUMO

BACKGROUND: Delirium in cardiac surgery patients is common and is associated with prolonged mechanical ventilation and hospital stay as well as higher mortality. Protocols may improve outcome. In our cardiac surgery intensive care unit (ICU), patients with delirium have not received standardized treatment so far. HYPOTHESIS: In cardiac surgery ICU patients, standardized delirium management will lead after a 4­week introduction, compared to nonstandardized treatment, to a reduction of delirium duration. METHODS: Prospective before/after study to evaluate a quality improvement project for delirium management over 12 weeks including 140 patients. INCLUSION CRITERIA: (a) ≥18 years, (b) consent for research with their data. EXCLUSION CRITERIA: (a) palliative status, (b) present during both the before/after phase, (c) pregnancy, (d) included in a competitive study, or (e) delirium not assessable. The implementation includes the introduction of a protocol with interprofessional training, bedside-teaching, pocket cards, posters, and reminders. The primary outcome is the duration of delirium, assessed four times a day with validated instruments. Secondary outcome measures include delirium incidence, duration of mechanical ventilation, length of stay in ICU and hospital, mortality, nursing/therapeutic interventions, cumulative doses of delirium-related drugs, and complications of delirium for a follow-up of 28 days. Empirical data will be analyzed with descriptive and inferential statistics. OBJECTIVES: The purpose of the study is a reduction of the duration and frequency of delirium in cardiac ICU patients and will provide evidence of the effect size of the introduction of a delirium management.


Assuntos
Delírio/diagnóstico , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Estudos Prospectivos , Respiração Artificial
19.
Age Ageing ; 49(4): 523-524, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32315386

RESUMO

Common symptoms of pandemic coronavirus disease (COVID-19) include fever and cough. We describe a 94-year-old man with well-controlled schizoaffective disorder, who presented with non-specific and atypical symptoms: delirium, low-grade pyrexia and abdominal pain. He was given antibiotics for infection of unknown source, subsequently refined to treatment for community-acquired pneumonia. Despite active treatment, he deteriorated with oxygen desaturation and tachypnoea. A repeat chest X-ray showed widespread opacification. A postmortem throat swab identified COVID-19 infection. He was treated in three wards over 5 days with no infection control precautions. This has implications for the screening, assessment and isolation of frail older people to COVID-specific clinical facilities and highlights the potential for spread among healthcare professionals and other patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Delírio/etiologia , Idoso Fragilizado , Fragilidade/epidemiologia , Pneumonia Viral/complicações , Idoso de 80 Anos ou mais , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Delírio/diagnóstico , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X
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