World delirium awareness and quality survey in 2023—a worldwide point prevalence study

World delirium awareness and quality survey in 2023—a worldwide point prevalence study

Delirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the risk of mortality and dementia.BACKGROUNDDelirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the...

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Published in:Age and ageing Vol. 53; no. 11
Main Authors: Lindroth, Heidi, Liu, Keibun, Szalacha, Laura, Ashkenazy, Shelly, Bellelli, Giuseppe, van den Boogaard, Mark, Caplan, Gideon, Chung, Chi Ryang, Elhadi, Muhammed, Gurjar, Mohan, Heras-La-Calle, Gabriel, Hoffman, Magdalena, Jeitziner, Marie-Madlen, Krewulak, Karla, Mailhot, Tanja, Morandi, Alessandro, Nawa, Ricardo Kenji, Oh, Esther S, Collet, Marie Oxenboell, Paulino, Maria Carolina, von Haken, Rebecca, Nydahl, Peter
Format: Journal Article
Language:English
Published: Oxford University Press 01-11-2024
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Research Paper
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Summary:Delirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the risk of mortality and dementia.BACKGROUNDDelirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the risk of mortality and dementia.To report on the global prevalence of clinically documented delirium and delirium-related clinical practices in wards caring for paediatric and adult patients in healthcare facilities.OBJECTIVESTo report on the global prevalence of clinically documented delirium and delirium-related clinical practices in wards caring for paediatric and adult patients in healthcare facilities.A prospective, cross-sectional, 39-question survey completed on World Delirium Awareness Day, 15 March 2023.DESIGNA prospective, cross-sectional, 39-question survey completed on World Delirium Awareness Day, 15 March 2023.Clinicians or researchers with access to clinical data.PARTICIPANTSClinicians or researchers with access to clinical data.The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. (4 h) and 8:00 p.m. (±4 h). Secondary outcomes included delirium-related care practices and barriers to use. Descriptive statistics were calculated and multilevel modelling was completed.MAIN OUTCOME AND MEASUREThe primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. (4 h) and 8:00 p.m. (±4 h). Secondary outcomes included delirium-related care practices and barriers to use. Descriptive statistics were calculated and multilevel modelling was completed.1664 wards submitted surveys from 44 countries, reporting on delirium assessments at 8:00 a.m. (n = 36 048) and 8:00 p.m. (n = 32 867); 61% reported use of validated delirium assessment tools. At 8:00 a.m., 18% (n = 2788/15 458) and at 8:00 p.m., 17.7% (n = 2454/13 860) were delirium positive. Top prevention measures were pain management (86.7%), mobilisation (81.4%) and adequate fluids (80.4%). Frequently reported pharmacologic interventions were benzodiazepines (52.7%) and haloperidol (46.2%). Top barriers included the shortage of staff (54.3%), lack of time to educate staff (48.6%) and missing knowledge about delirium (38%).RESULTS1664 wards submitted surveys from 44 countries, reporting on delirium assessments at 8:00 a.m. (n = 36 048) and 8:00 p.m. (n = 32 867); 61% reported use of validated delirium assessment tools. At 8:00 a.m., 18% (n = 2788/15 458) and at 8:00 p.m., 17.7% (n = 2454/13 860) were delirium positive. Top prevention measures were pain management (86.7%), mobilisation (81.4%) and adequate fluids (80.4%). Frequently reported pharmacologic interventions were benzodiazepines (52.7%) and haloperidol (46.2%). Top barriers included the shortage of staff (54.3%), lack of time to educate staff (48.6%) and missing knowledge about delirium (38%).In this study, approximately one out of five patients were reported as delirious. The reported high use of benzodiazepines needs further evaluation as it is not aligned with best-practice recommendations. Findings provide a benchmark for future quality improvement projects and research.CONCLUSION AND RELEVANCEIn this study, approximately one out of five patients were reported as delirious. The reported high use of benzodiazepines needs further evaluation as it is not aligned with best-practice recommendations. Findings provide a benchmark for future quality improvement projects and research.
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Acknowledgement of Collaborative Authorship: The World Delirium Awareness Day (WDAD) Study Team consists of: Ahmed Gaber Ahmed Abdalgany, MBBCH, Sarah Magdy Abdelmohsen, M.D., Amjad Aburaas, M.D., Christina Aggar, M.D., Bashir Abobaker Albakosh, M.D., Hamza Ismail Ahmad Alhamdan, M.D., Akram Waled Rajab M Aljbali, M.D., Farah Alkandari, M.D., Akram Alkaseek, MBBCh, MRCS, Daniel Anders, R.N., Marsali Anderson, MB ChB, BSc, Thiago Avelino, Kasia Siobhan Bail, Ashraf Bakri, M.D., Alaa Mohamed Ali Baroum, Julie Benbenishty, Ph.D., MNS, R.N., Bronagh Blackwood, Ph.D., Jennifer Brendt-Müller, MSc, Angelika Brobeil, BBA, Richard Burke, M.D., Tru Byrnes, D.N.P., Stefano Cacciatore, M.D., Maria Cahill, MSc, Maria Ana Canelas, Ida Carroll, MSc, Amy Conley, MbChB, Maria Costello, M.D., Shannon Cotton, R.N., Mandy Couser, BSc, Ana Rita Cunha Salgado, M.D., Elizabeth Cusworth, MS, Vera Cvoro, M.D., Jordanna Deosaran, M.D., Merel Diebels, MSc, Elaine A. Docherty, MHp, Vera von Dossow, M.D., Megan Drennan, M.D., Akram Amin Egdeer, MBBCh, Patrick Eichelsheim, MANP, Aissha Ali Saleh Elagili, M.D., Saifaleslam Jamal Elsahl, M.D., Hajer Alsadeg Mohammed Elshaikh, M.D., Christina Emme, Ph.D., Matthias Thomas Exl, MSc, Azza Fathi, M.D., Melanie Feige, Dipl. Paed., Kirsten Fiest, Ph.D., Marleta Irene Joy Fong, MsN, Mikita Fuchita, M.D., Carol Gaffney, M.D., Carola Gimenez-Esparza Vich, M.D., Nicole Feldmann, MSc, Rachel Fitzgerald, M.D., Neasa Fitzpatrick, M.D., Marleta Irene Joy Fong, MN CN, Maria Adela Goldberg, M.D., Nienke Golüke, M.D., Mirjam de Graaf, MSc, Engelina Groenewald, M.D., Renate Gross, M.D., Camilla Grube Segers, M.D., Renate Hadi, R.N., Qusai Ahmad Hasan Hamdan, BS, Bahaeddin Ben Hamida, MBBCh, Mohamed Hassan Hamza. M.D., Breanna Hetland, Ph.D., Jane Adele Hopkins, MHA, John Hopkins, MBChB, FRCPsych, Sarah Ahmed Atef Mohamed Ibrahim, MBBCH, Guglielmo Imbriaco RN MSN, on behalf of Aniarti, Italian Association of Critical Care Nurses, Azienda USL di Bologna Italy, Shigeaki Inoue, Ph.D., Arveen Jeyaseelan, M.D., Ali Jawad Kadhim, MBChB, Sabrina Kohler, MBBS FRACP, Rens Kooken, M.D., Anna St. Korompeli, Ph.D., Lars Krüger, MSc, Ayman Salim Abu Khutwah, Puck de Lange, M.D., Sharon Liefrink, R.N., Yu-min Lin, M.D., Shi Pei Loo, M.D., Sara Beatriz Lopes Rodrigues, M.D., Allan MacDonald, M.D., Gillian Madders, M.D., Claudia Massaro, M.D., Kerri Maya, MSL, Sofia Manioudaki, M.D., Natalie McAndrew, P.hD., Stewart McKenna, M.D., Isabel Maria Metelo Coimbra, M.D., Teresa Miranda, M.D., Mohamed Anwar Abdelsalam Mohamed, M.D., Mushin Mohammed Elhadi Agbna Mohammed, M.D., Malissa Mulkey, Ph.D., Fariha Naeem, M.D., Kensuke Nakamura, Ph.D., Mi-Ryeo Nam, Elaine Newman, MSc, Renae Nicol, CNC, Claire Noonan, Msc AP, Maria Inês Nunes Oliveira Lopes, M.D., Zina Otmani, Cynthia Olotu, M.D., Alice Margherita Ornago, M.D., Susan O’Reilly, MSc, Valerie Ozorio, M.D., Jessica Palakashappa, M.D., Tej Pandya, M.D., Panagiota Papadea, M.D., Metaxia Papanikolaou, M.D., Rose S. Penfold, MPH, Elena Pinardi, M.D., Inês Filipa Pinto Pereira, M.D., Chirantha Premathilaka, M.D., Monica Pop-Purceleanu, M.D., Marlene Puchegger, BSc, Nouralddeen Mohammed Qalhoud, M.D., Terence J. Quinn, M.D., Maike Raasing, Ph.D., Dalia Talaat Ragheb, M.D., Prasad Rajhans, M.D., Nuri Ramadan, M.D., Mushabbir Hossain Rubel, M.D., Kate Sainsbury, BSc, Francesco Salis, M.D., Florian Schimböck, MSc Med, Roman Schmädig, MSc, Yvonne Schoon, M.D., Deepak Sethia, M.D., Edith Sextl, MScN, Bhagyesh Shah, M.D., Dua’a Shaout, M.D., Alaa Fouad Sharabi, M.D., Lynn Shields, M.D., Kendall Smith, M.D., Linda Smulders-van Dam, MSc, Roy L Soiza, M.D., Andrea Spiegler, MSc, Lucy Stocks, MBBS, Stefan Sumerauer, MSc, Stephanie Tam, BSc, Aik Haw Tan, MBChB, FRACP, Suzanne Timmons, Ph.D., Peter Tohsche, MScN, Raquel Gouveia Torres, M.D., Chantal Toth, D.N.P., Vasiliki Tsolaki, Ph.D., Iben Tousgaard, MPH, Roberta Esteves Vieira de Castro, Birgit Vogt, M.D., Erica Walsh, M.D., Kristel Ward-Stockham, MANP, Melinda Webb-St. Mart, MPH, Franziska Wefer, MSc, Mariajne Elisabeth Wijnen-Meijer, Ph.D., Hilde Wøien, M.D., Inke Zastrow, MSc, Maria Beatrice Zazzara, M.D.
ISSN:0002-0729
1468-2834
1468-2834
DOI:10.1093/ageing/afae248