Delirium Bibliography

Reference Information

Title

Characterizing medical patients with delirium: A cohort study comparing ICD-10 codes and a validated chart review method

Authors

Sheehan, K. A. Shin, S. Hall, E. Mak, D. Y. F. Lapointe-Shaw, L. Tang, T. Marwaha, S. Gandell, D. Rawal, S. Inouye, S. Verma, A. A. Razak, F.

Year

2024

Journal

PLoS One

Abstract

BACKGROUND: Delirium is a major cause of preventable mortality and morbidity in hospitalized adults, but accurately determining rates of delirium remains a challenge. OBJECTIVE: To characterize and compare medical inpatients identified as having delirium using two common methods, administrative data and retrospective chart review. METHODS: We conducted a retrospective study of 3881 randomly selected internal medicine hospital admissions from six acute care hospitals in Toronto and Mississauga, Ontario, Canada. Delirium status was determined using ICD-10-CA codes from hospital administrative data and through a previously validated chart review method. Baseline sociodemographic and clinical characteristics, processes of care and outcomes were compared across those without delirium in hospital and those with delirium as determined by administrative data and chart review. RESULTS: Delirium was identified in 6.3% of admissions by ICD-10-CA codes compared to 25.7% by chart review. Using chart review as the reference standard, ICD-10-CA codes for delirium had sensitivity 24.1% (95%CI: 21.5-26.8%), specificity 99.8% (95%CI: 99.5-99.9%), positive predictive value 97.6% (95%CI: 94.6-98.9%), and negative predictive value 79.2% (95%CI: 78.6-79.7%). Age over 80, male gender, and Charlson comorbidity index greater than 2 were associated with misclassification of delirium. Inpatient mortality and median costs of care were greater in patients determined to have delirium by ICD-10-CA codes (5.8% greater mortality, 95% CI: 2.0-9.5 and $6824 greater cost, 95%CI: 4713-9264) and by chart review (11.9% greater mortality, 95%CI: 9.5-14.2% and $4967 greater cost, 95%CI: 4415-5701), compared to patients without delirium. CONCLUSIONS: Administrative data are specific but highly insensitive, missing most cases of delirium in hospital. Mortality and costs of care were greater for both the delirium cases that were detected and missed by administrative data. Better methods of routinely measuring delirium in hospital are needed.

PMID

PMID: 38739670

PMCID: PMC11090329

Keywords

Humans
*Delirium/diagnosis/epidemiology
Male
Female
*International Classification of Diseases
Aged
Retrospective Studies
Middle Aged
Aged, 80 and over
Ontario/epidemiology
Hospitalization
Cohort Studies

Page(s)

Volume

Issue