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Vol. 219. Issue 8.
Pages 415-423 (November 2019)
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Vol. 219. Issue 8.
Pages 415-423 (November 2019)
Original article
Clinical characteristics and prognosis for delirium in Spanish internal medicine departments: An analysis from a large clinical-administrative database
Características clínicas del delirio y sus implicaciones pronósticas en los servicios de medicina interna españoles: análisis de una gran base de datos clínico-administrativa
J. Marcoa,
Corresponding author
javiermarco.z@gmail.com

Corresponding author.
, M. Méndeza, A.J. Cruz-Jentoftb, J.L. García Klepziga, E. Calvoa, J. Canorac, A. Zapateroc, R. Barbad
a Departmento de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain
b Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
c Departamento de Medicina Interna, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain
d Departamento de Medicina Interna, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
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Figures (2)
Tables (6)
Table 1. Analysis by age group of delirium in spanish internal medicine departments (2007–2014).
Table 2. Univariate analysis of the secondary diagnosis codes associated with delirium in the internal medicine departments (2007–2014).
Table 3. Logistic regression analysis of the comorbidities associated with delirium in Spanish internal medicine departments (2007–2014).
Table 4. Multiple logistic regression analysis of the association between death during hospitalization and delirium, age and sex in Spanish internal medicine departments (2007–2014).
Table 5. Univariate statistical analysis of the procedures associated with delirium in Spanish internal medicine departments (2007–2014).
Table 6. Logistic regression analysis of the association between delirium during hospitalization and the use of urinary catheters, nasogastric tubes and central venous catheters in Spanish internal medicine departments (2007–2014).
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Abstract
Objectives

To investigate the prevalence of reported delirium and its associated factors and costs.

Design

Retrospective and descriptive analysis of a national clinical-administrative database that includes all patients hospitalized in Spain in internal medicine departments from January 2007 to December 2014.

Material and method

The study included the patients’ sociodemographic and clinical data (sex, age, diagnosis and procedures).

Results

The prevalence of reported delirium was 2.5% (114,343 of 4,628,397 discharge reports). Delirium was most common in the 81–90-year age group (48%) and in institutionalized patients (4.5% vs. 2.9%; p<.001). The diagnoses most associated with delirium were dementia (14% vs. 7% for patients without delirium), cerebrovascular disease (17% vs. 11%), malnutrition (4% vs. 2%), pressure ulcers (4% vs. 2%), dysphagia (2% vs. 0.2%) and hyponatraemia (5% vs. 2%) (p<.001 in all cases). Patients with delirium also had longer mean stays (11.85±13.15days vs. 9.49±11.17) and higher hospital mortality (OR: 1.41; 95%CI: 1.39–1.43; p=.0001).

The costs attributable to delirium in 8 years exceeded €100 million (almost €1000 per hospitalization/patient). We developed a predictive model for the risk of developing delirium, which has insufficient sensitivity but is useful for identifying low-risk patients.

Conclusions

Patients who develop delirium during their hospitalization in internal medicine have a longer stay, greater mortality and an increased risk of being institutionalized at discharge. Delirium is probably poorly reported in the discharge reports prepared by internists.

Keywords:
Delirium
Prognosis
Mortality risk
Elderly
Internal medicine
Big data
Resumen
Objetivos

Investigar la prevalencia del delirio reportado, los factores asociados y los costes.

Diseño

Análisis retrospectivo y descriptivo de una base de datos clínico-administrativa nacional que incluye todos los pacientes ingresados en España en los servicios de medicina interna desde enero de 2007 a diciembre de 2014.

Material y método

Se incluyen datos sociodemográficos y clínicos (sexo, edad, diagnóstico y procedimientos), entre otros.

Resultados

La prevalencia del delirio reportado fue del 2,5% (114.343 de 4.628.397 informes de alta). El delirio fue más frecuente en el grupo de 81 a 90 años (48%) y en pacientes institucionalizados (4,5% vs 2,9%; p<0,001). Los diagnósticos más asociados al delirio fueron demencia (14% vs 7% en los sujetos sin delirio), enfermedad cerebrovascular (17% vs 11%), desnutrición (4% vs 2%), úlceras por presión (4% vs 2%), disfagia (2% vs 0,2%) e hiponatremia (5% vs 2%); p<0,001 en todos los casos. También tuvieron una estancia media más larga: 11,85 (DE: 13,15) días vs 9,49 (DE: 11,17) días, y mortalidad intrahospitalaria más elevada (OR: 1,41; IC95%: 1,39-1,43; p=0,0001).

El coste atribuible al delirio en 8años supera los 100 millones de euros (casi 1.000€ por ingreso/paciente). Elaboramos un modelo predictivo del riesgo de desarrollar delirio sin sensibilidad suficiente pero útil para identificar pacientes de bajo riesgo.

Conclusiones

Los pacientes que desarrollan delirio durante su ingreso en medicina interna tienen una estancia más prolongada, mayor mortalidad y mayor riesgo de ser institucionalizados al alta. El delirio está probablemente poco reportado en los informes de alta que elaboran los internistas.

Palabras clave:
Delirio
Pronóstico
Riesgo de mortalidad
Anciano
Medicina interna
Big data

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