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Emergency doctors often fail to detect delirium in advanced cancer patients

Delirium is the most common neuro-psychiatric syndrome in patients with advanced cancer but it often goes undetected in the emergency department, new research suggests. 

Most delirium studies in cancer patients have been limited to palliative care settings, while those in emergency departments have been limited to elderly patients. So researchers from the University of Texas studied 243 patients with advanced cancer, aged between 19 and 89 years, who presented to the emergency department. 

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The confusion assessment method (CAM) was used to screen for delirium and the memorial delirium assessment scale (MDAS) measured delirium severity. 

The researchers found that 9% of those studied had CAM-positive delirium. Among CAM-positive patients, delirium was mild in 82% and moderate in 18% according to the MDAS scale. Of 99 patients aged 65 years and older, 10% had CAM-positive delirium compared with 8% of 144 patients younger than 65 years. 

When emergency department physicians were asked whether their patients were delirious, they failed to detect delirium in 41% of CAM-positive delirious patients, the researchers said. 

Lead study author Knox Todd said the study also identified many psychoactive medications that could have contributed to delirium. ‘Sharing this information with treating oncologists may help them avoid such complications in the next patient they treat’ he said. 

Elsayem A et al (2016) Delirium frequency among advanced cancer patients presenting to an emergency department: A prospective, randomized, observational study. Cancer. doi:10.1002/cncr.30133

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