All ETDs from UAB

Advisory Committee Chair

Richard E Kennedy

Advisory Committee Members

Erik P Hess

Emily B Levitan

Document Type

Thesis

Date of Award

2021

Degree Name by School

Master of Science in Public Health (MSPH) School of Public Health

Abstract

Objectives: Delirium affects 7-17% of older Emergency Department (ED) patients. Inadequate pain control and opioid pain management have been reported to increase risk for delirium. The aim of this study was to evaluate the association between pain severity, opioid exposure, and delirium among older ED patients.Methods: A single-center retrospective cohort study was conducted in an academic Geriatric ED. Patients aged ≥65 years with an Identification of Seniors at Risk (ISAR) score ≥2 and an Emergency Severity Index (ESI) level 3 were enrolled into the Geriatric ED Pathway. Those who received a delirium screening using the Nursing Delirium Screening Scale (NuDESC) and admitted to a non-ICU unit between January-December 2020 were included. To evaluate the effect of ED opioid exposure on delirium controlling for a priori confounding risk factors, multivariable logistic regression analyses were performed. Results: A total of 255 patients were included. Thirty-four (13.3%) and 48 (18.8%) patients were identified as delirious in the ED and within 24 hours of admission, respectively. Delirious and non-delirious ED patients had similar rates of ED opioid administration (26% vs 32%, p=0.508), but delirious patients had lower pain severity (severe pain score ≥ 7, 12% vs. 42%, p=0.001) and were more likely to have urinary foley catheters placed (21% vs. 8%, p=0.026). Controlling for a priori risk factors, being aged ≥85 years (adjusted OR 6.07, 95% CI 1.12-33.07) and having Charlson Comorbidity Index (CCI) dementia (adjusted OR 22.18, 95% CI 6.56-75.03) were associated with higher risk of ED delirium, but ED opioid administration and ED severe pain intensity were not. ED urinary foley catheter placement (adjusted OR 3.42, 95% CI 0.97-12.10) was associated with higher risk of delirium 24 hours postadmission. Conclusions: Advanced age ≥85 years and dementia, not pain severity or opioid exposure, were associated with ED delirium. Further, ED urinary foley catheters were associated with inpatient delirium within the first 24 hours of admission. Ultimately, results may positively impact Geriatric ED care by improving emergency physicians’ awareness of older adults at risk for delirium and the potential consequences of inadequate pain control and acute opioid treatment on the development of delirium.

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