Prevalence and outcome of delirium amongst acute general medical inpatients in Cape Town, South Africa

Master Thesis


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Objectives Delirium is a common, serious, underdiagnosed condition in acute medical and surgical inpatients. It is associated with increased risk of mortality and morbidity. Data are largely limited to developed countries in geriatric cohorts. Here we describe prevalence, risk factors and outcomes of delirium amongst general medical patients admitted to two hospitals in Cape Town, South Africa. Design and Setting Prospective cohort study of patients admitted acutely to a general medical inpatient service, in a secondary and tertiary-level public hospital serving the Metro West area of Cape Town, South Africa. Participants Patients ≥ 18 years old were recruited daily from all acute medical admissions. Patients were excluded if they were aphasic or had Glasgow Coma Scale < 12/15. In total, 808 patients were included. Main outcome measures Delirium was diagnosed using the validated confusion assessment method (CAM) tool performed by trained neuropsychologists. Demographic data was collected by a clinical team and short and long-term mortality data were obtained using linkage analysis of hospitalised patients to routinely collected provincial death certification records. Results: The median age of inpatients was 51 (36-65) years. Twenty nine percent were proven HIV-infected. The overall prevalence of delirium was 12.3%. Multivariate predictors of delirium included: the presence of an indwelling urinary catheter (OR 4.37, CI 2.36-8.03), admission with a central nervous system disease (OR 4.37, CI 2.39-7.98), pre-existing cognitive impairment (OR 2.72, CI 1.11-6.64) and admission with a terminal disease (OR 3.11, CI 1.09-8.89). HIV infection was not associated with increased risk of delirium. Delirium was associated with an increased risk for in-hospital (delirium vs. no delirium: 29% vs 12%; p<0.01) and 12-month mortality (30% vs 20%; p < 0.01), as well as increased length of hospital stay (7 days vs 5 days, p < 0 .01). Conclusion: In this cohort of medical in-patients (with a relative young age and high HIV prevalence,) one in eight (12.3%) are delirious.. Delirium was associated with adverse outcomes. Delirium risk factors in this young cohort are similar to those in geriatric cohorts in developed countries, and neither HIV nor opportunistic infections increased risk.