Cognitive screening in the emergency department: a practical method for front-door identification of risks in older patients admitted to hospitals

• Grant number: 23/13888-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: May 01, 2024
• End date: November 30, 2024
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Marlon Juliano Romero Aliberti
• Grantee: Gabriel Stanziola de Moraes
• Host Institution: Hospital Sírio-Libanês. Sociedade Beneficente de Senhoras (SBSHSL). São Paulo , SP, Brazil

Abstract

Although the detection of delirium is essential for identifying elderly patients admitted to emergency and urgency departments at high risk of adverse outcomes, the debate on cognitive screening beyond delirium continues. In this study, the aim is to evaluate the predictive power of cognitive impairment, both with and without delirium, in elderly patients admitted for acute conditions. The data comes from a prospective cohort of patients aged 65 and older, admitted to the Sirio-Libanes Hospital in São Paulo, following an emergency room visit. Delirium was assessed using the brief Confusion Assessment Method (bCAM), and patients without delirium were evaluated with the 10-point Cognitive Screener (10-CS), a practical 2-minute test to detect pre-existing cognitive impairment. The cognitive status will be categorized as: normal (bCAM negative and 10-CS>5), pre-existing cognitive impairment (bCAM negative, but 10-CSd5), or delirium (bCAM positive). Trained researchers, without access to admission data, conducted structured telephone interviews up to 90 days after admission, aiming to identify functional loss (Katz index) and death. The relationship between cognitive status at admission and outcomes up to 90 days will be analyzed using proportional hazard models, adjusted for standard risk factors commonly assessed in emergency units. It is anticipated that screening for pre-existing cognitive impairment will add prognostic value to delirium. This comprehensive and pragmatic cognitive assessment has the potential to guide healthcare professionals in therapeutic decisions aligned with the risk profile of elderly patients.