Delirium in elderly patients in emergency department

• Grant number: 21/12478-9
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2022
• End date: December 31, 2022
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Heraldo Possolo de Souza
• Grantee: Agnes Araujo Sardinha Pinto
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated research grant: 16/14566-4 - Diagnostic and prognostic markers in patients admitted to an emergency department, AP.TEM

Abstract

Delirium is defined as a state of a lowered level of consciousness, with a sudden onset or rapid evolution, which may be associated with agitation and hallucinations. It occurs more commonly in the elderly, as a complication of other disorders, whether infectious, toxic, or metabolic. Its diagnosis is based on the clinical picture that may be difficult to be perceived initially. There is still no serum marker to identify patients with delirium, and studies on this focus mainly on the prevention of delirium in elderly hospitalized patients. For the patient admitted to the Emergency Room, these markers are less useful, since generally the lowered level of consciousness or behavior change are already the causes of seeking medical care. In the emergency service, the most important thing is to be able to use markers that are capable of:- discern the diagnosis of delirium from other central nervous system disorders- determining the severity of the neurological condition- serving as prognostic markers- being useful for measuring the evolution of the framework. Thus, our objective is to determine whether clinical scores, associated or not with circulating markers, can serve as markers for the diagnosis and/or prognosis of patients with delirium associated with infectious conditions. The strategy will include all elderly patients (over 65 years old) admitted to the HCFMUSP Referenced Emergency Unit due to an infectious condition, with or without change in the level of consciousness without acute structural injury, who will be included in the study. Upon admission to the service, these patients will undergo a clinical and neurological examination (with the execution of the CAM) and, if necessary, imaging tests to exclude acute brain injury. Then, blood samples will be taken. A second sample will be taken:- in patients who have already entered the service in delirium, the second sample will be collected on the third day of hospitalization or when the patient presents an improvement in the level of consciousness- in patients with an infectious condition, without delirium, the second sample will be collected on the day of discharge, or if the patients go into delirium. In these blood samples, brain injury markers (S100B, NSE) or inflammatory markers (cytokines, neopterin) will be measured. The clinical picture and its evolution will be related to the serum dosages of these markers. Samples will also be collected from patients who will serve as negative controls (healthy elderly) or positive (elderly with head trauma or stroke). Our results can be very useful in identifying, screening, and classifying elderly patients in Emergency Services, bringing improvements to the care of these patients.(AU)