Abstract Details

Title Delirium in Hospitalized Adults with Confirmed SARS-CoV-2 Infection

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) Behavioral and Cognitive Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 003

Objective

Determine the clinical characteristics and proportion of delirium in all hospitalized adults diagnosed with a SARS-CoV-2 infection at a single tertiary academic center.

Background

Despite growing recognition for the neurological complications associated with SARS-CoV-2 infection, delirium in this population is poorly characterized and prior research is predominantly limited to ICU populations.

Design/Methods In this retrospective cohort study, we included all individuals at least 18 years old with diagnosed coronavirus disease 19 (COVID-19) using reverse transcriptase polymerase chain reaction for SARS-CoV-2 hospitalized at least 48-hours from February 1, 2020-July 15, 2020. Diagnosis of COVID-19 was identified using ICD-10 code U07.1 in our Clarity database. Systematic, daily delirium screening by trained nursing staff occurred for all patients each shift as part of our Delirium Care Pathway. Screening included Nursing Delirium Screening Scale (NuDESC) in medical-surgical ward patients, and Confusion Assessment Method ICU (CAM-ICU) in ICU patients. Differences between delirious and non-delirious patients were calculated using Wilcoxon rank-sum tests or Fisher’s exact tests where appropriate.

Results We included 99 patients diagnosed with COVID-19, of whom 46 patients were only on a medical-surgical ward. Forty-three percent of patients were delirious. Delirious patients were older than non-delirious patients: median(IQR) 62(47-81) vs. 48(38-63) years old (Z=-3.3, p=0.001). Seventy percent of delirious patients were cared for in the ICU at any point during hospitalization, compared with 25% of non-delirious patients (p <0.001). Compared with non-delirious patients, delirious patients had a longer median length of stay in days [8(4-13) vs 14(11-27); Z=-4.2, p<0.001], more likely to have a safety attendant (28% vs 7%, p=0.01), restraints (58% vs 5%, p<0.001), and less likely to be discharged home (39% vs 84%, p<0.001).

Conclusions

Delirium is common among hospitalized patients with COVID-19, especially in older adults and those requiring ICU-level care, and it is associated with important differences in both resource utilization and hospital trajectory.

Authors/Disclosures
Sara LaHue, MD PRESENTER	The institution of Dr. LaHue has received research support from National Institute on Aging . The institution of Dr. LaHue has received research support from Larry L. Hillblom Foundation . The institution of Dr. LaHue has received research support from UCSF Claude D. Pepper Older Americans Independence Center . The institution of Dr. LaHue has received research support from UCSF Bakar Aging Research Institute. The institution of Dr. LaHue has received research support from Doris Duke Foundation . Dr. LaHue has received publishing royalties from a publication relating to health care.
	No disclosure on file
Elan Guterman, MD (University of California, San Francisco)	Dr. Guterman has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Guterman has stock in REMO Health. The institution of Dr. Guterman has received research support from NIH. The institution of Dr. Guterman has received research support from AAN.
Vanja C. Douglas, MD, FAAN (Univ of California, San Francisco)	Dr. Douglas has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Various legal firms. Dr. Douglas has received publishing royalties from a publication relating to health care. Dr. Douglas has received publishing royalties from a publication relating to health care.
John Newman (Buck Institute for Research on Aging)	John Newman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Junevity. John Newman has stock in BHB Therapeutics. John Newman has stock in Selah Therapeutics. The institution of John Newman has received research support from NIH. The institution of John Newman has received research support from Hevolution Foundation. The institution of John Newman has received research support from ARPA-H. The institution of John Newman has received research support from US Department of Defense. The institution of an immediate family member of John Newman has received research support from The Fibrolamellar Cancer Foundation. John Newman has received intellectual property interests from a discovery or technology relating to health care. John Newman has received intellectual property interests from a discovery or technology relating to health care. John Newman has received publishing royalties from a publication relating to health care. An immediate family member of John Newman has received personal compensation in the range of $500-$4,999 for serving as a Committee Voting Member with NIH. John Newman has received personal compensation in the range of $0-$499 for serving as a Peer Reviewer with NIH. John Newman has received personal compensation in the range of $500-$4,999 for serving as a DSMB Member with NIH.

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