229 research outputs found
Trends in delirium coding rates in older hospital inpatients in England and Scotland: full population data comprising 7.7M patients per year show substantial increases between 2012 and 2020
Background: Little information is available on change in delirium coding rates over time in major healthcare systems. We examined trends in delirium discharge coding rates in older patients in hospital admissions to the National Health Service (NHS) in England and Scotland between 2012 and 2020. /
Methods: Hospital administrative coding data were sourced from NHS Digital England and Public Health Scotland. We examined rates of delirium (F05 from ICD-10) in patients aged ≥70 years in 5 year and ≥90 age bands. /
Results: There were approximately 7,000,000 discharges/year in England and 700,000/year in Scotland. Substantially increased delirium coding was observed for all age bands between 2012/2013 and 2019/2020 (p<0.001, Mann Kendall’s tau). In the ≥90 age band, there was a 4-fold increase between 2012 and 2020. /
Conclusion: Delirium coding rates have shown large increases in the NHS in England and Scotland, likely reflecting several factors including policy initiatives, detection tool implementation and education
Development and initial testing of normal reference MR images for the brain at ages 65-70 and 75-80 years
Trends in delirium coding rates in older hospital inpatients in England and Scotland:full population data comprising 7.7M patients per year show substantial increases between 2012 and 2020
BackgroundLittle information is available on change in delirium coding rates over time in major healthcare systems. We examined trends in delirium discharge coding rates in older patients in hospital admissions to the National Health Service (NHS) in England and Scotland between 2012 and 2020.MethodsHospital administrative coding data were sourced from NHS Digital England and Public Health Scotland. We examined rates of delirium (F05 from ICD-10) in patients aged ≥70 years in 5 year and ≥90 age bands.ResultsThere were approximately 7,000,000 discharges/year in England and 700,000/year in Scotland. Substantially increased delirium coding was observed for all age bands between 2012/2013 and 2019/2020 (p<0.001, Mann Kendall’s tau). In the ≥90 age band, there was a 4-fold increase between 2012 and 2020.ConclusionDelirium coding rates have shown large increases in the NHS in England and Scotland, likely reflecting several factors including policy initiatives, detection tool implementation and education
Vaccination against COVID-19 reduced the mortality risk of COVID-positive hip fracture patients to baseline levels:the nationwide data-linked IMPACT Protect study
SummaryThis nationwide study used data-linked records to assess the effect of COVID-19 vaccination among hip fracture patients. Vaccination was associated with a lower risk of contracting COVID-19 and, among COVID-positive patients, it reduced the mortality risk to that of COVID-negative patients. This provides essential data for future communicable disease outbreaks.PurposeCOVID-19 confers a three-fold increased mortality risk among hip fracture patients. The aims were to investigate whether vaccination was associated with: i) lower mortality risk, and ii) lower likelihood of contracting COVID-19 within 30 days of fracture.MethodsThis nationwide cohort study included all patients aged > 50 years that sustained a hip fracture in Scotland between 01/03/20–31/12/21. Data from the Scottish Hip Fracture Audit were collected and included: demographics, injury and management variables, discharge destination, and 30-day mortality status. These variables were linked to government-managed population level records of COVID-19 vaccination and laboratory testing.ResultsThere were 13,345 patients with a median age of 82.0 years (IQR 74.0–88.0), and 9329/13345 (69.9%) were female. Of 3022/13345 (22.6%) patients diagnosed with COVID-19, 606/13345 (4.5%) were COVID-positive within 30 days of fracture. Multivariable logistic regression demonstrated that vaccinated patients were less likely to be COVID-positive (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.34–0.48, p < 0.001) than unvaccinated patients. 30-day mortality rate was higher for COVID-positive than COVID-negative patients (15.8% vs 7.9%, p < 0.001). Controlling for confounders (age, sex, comorbidity, deprivation, pre-fracture residence), unvaccinated patients with COVID-19 had a greater mortality risk than COVID-negative patients (OR 2.77, CI 2.12–3.62, p < 0.001), but vaccinated COVID19-positive patients were not at increased risk of death (OR 0.93, CI 0.53–1.60, p = 0.783).ConclusionVaccination was associated with lower COVID-19 infection risk. Vaccinated COVID-positive patients had a similar mortality risk to COVID-negative patients, suggesting a reduced severity of infection. This study demonstrates the efficacy of vaccination in this vulnerable patient group, and presents data that will be valid in the management of future outbreaks
The observational scale of level of arousal: a brief tool for assessing and monitoring level of arousal in patients with delirium outside the ICU
Detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure
Detecting delirium superimposed on dementia (DSD) can be challenging because assessment partly relies on cognitive tests that may be abnormal in both conditions. We hypothesized that a combined arousal and attention testing procedure would accurately detect DSD.
Patients aged ≥70 years were recruited from five hospitals across Europe. Delirium was diagnosed by physicians using DSM-5 criteria using information from nurses, carers, and medical records. Dementia was ascertained by the Informant Questionnaire on Cognitive Decline in the Elderly. Arousal was measured using the Observational Scale of Level of Arousal (OSLA), which assesses eye opening, eye contact, posture, movement, and communication. Attention was measured by participants signaling each time an “A” was heard when “S-A-V-E-A-H-A-A-R-T” was read out.
The sample included 114 persons (mean age 82 years (SD 7); 54% women). Dementia alone was present in 25% (n = 28), delirium alone in 18% (n = 21), DSD in 27% (n = 31), and neither in 30% (n = 34). Arousal and attention was assessed in n = 109 (96%). Using OSLA, 83% participants were correctly identified as having delirium (sensitivity 85%, specificity 82%, AUROC 0.92). The attention task correctly classified 76% of participants with delirium (sensitivity 90%, specificity 64%, AUROC 0.80). Combining scores correctly classified 91% of participants with delirium (sensitivity 84%, specificity 92%, AUROC 0.94). Diagnostic accuracy remained high in the subgroup with dementia (93% correctly classified, sensitivity 94%, specificity 92%, AUROC 0.98).
This combined arousal–attention assessment to detect DSD was brief yet had high diagnostic accuracy. Such an approach could have clinical utility for diagnosing DSD
Lessons learned from hip fracture registries - From the Scottish perspective to global practice
Corrigendum to Correlational structure of ‘frontal’ tests and intelligence tests indicates two components with asymmetrical neurostructural correlates in old age Intelligence 46 (2014) 94–106
ABCD Neurocognitive Prediction Challenge 2019: Predicting individual fluid intelligence scores from structural MRI using probabilistic segmentation and kernel ridge regression
We applied several regression and deep learning methods to predict fluid
intelligence scores from T1-weighted MRI scans as part of the ABCD
Neurocognitive Prediction Challenge (ABCD-NP-Challenge) 2019. We used voxel
intensities and probabilistic tissue-type labels derived from these as features
to train the models. The best predictive performance (lowest mean-squared
error) came from Kernel Ridge Regression (KRR; ), which produced a
mean-squared error of 69.7204 on the validation set and 92.1298 on the test
set. This placed our group in the fifth position on the validation leader board
and first place on the final (test) leader board.Comment: Winning entry in the ABCD Neurocognitive Prediction Challenge at
MICCAI 2019. 7 pages plus references, 3 figures, 1 tabl
Increasing delirium skills at the front door: results from a repeated survey on delirium knowledge and attitudes
Background: delirium is under-recognised in comparison to other common and serious acute disorders. A 2006 survey of
UK junior doctors (not undertaking specialist training) identified poor knowledge of the diagnostic criteria and treatment of
delirium. We hypothesised that increased prominence accorded to delirium in the form of national initiatives and guidelines
may have had an impact on understanding among junior doctors.
Objective: we repeated a multi-centre survey of knowledge of and attitudes to delirium in junior doctors (not undertaking
specialist training) assessing unselected acute medical presentations (the ‘medical take’).
Design: questionnaire-based survey in 48 acute hospitals in UK and Ireland.
Methods: we used questionnaires designed to test understanding of delirium, including prevalence, knowledge of the DSMIV
diagnostic criteria, use of specific screening tools, association with adverse outcomes and pharmacological management.
Results: one thousand two hundred and fifteen trainee physicians participated. Compared with the 2006 cohort, improvements
were seen in 9 of 17 knowledge-based questions and overall score improved in the 2013 cohort. Nonetheless, significant
deficits in knowledge, particularly for the diagnostic criteria for delirium, remained.
Conclusions: despite improvements in some aspects of delirium knowledge, the diagnostic criteria for delirium remain poorly
understood. Challenges remain in ensuring adequate training for junior doctors in delirium
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