Year 2018 / Volume 25 / Number 4

Reader rating:
Rate this article:
Send by e-mail
Download PDF
Este artículo ha sido visitado 51504 veces.
Este artículo ha sido descargado 19 veces.


Original

Prevalence of delirium using the Memorial Delirium Assessment Scale (MDAS) in advanced oncology patients admitted to a Palliative Care Unit. Risk factors, reversibility and treatment received

Med Paliat. 2018;25(4):245-254

Verónica Díaz García,, Miriam López Pérez e Yolanda Zuriarrain Reyna


ABSTRACT

Introduction: Delirium is a common symptom in patients with advanced cancer, despite being under diagnosed and therefore not appropriately treated. Its correct identification using scales and the detection of the possible risk factors is critical to improve symptoms control.

Objective: To determine the prevalence of delirium using the Memorial Delirium Assessment Scale (MDAS) as a screening and diagnostic tool, to assess the reversibility of episodes and to identify its risk factors.

Method: Prospective and observational study of patients diagnosed with advanced oncologic disease, consecutively admitted to a Palliative Care Unit (PCU), during a period of 4 months with follow-up of same until discharge or death. Patients with moderate-severe cognitive impairment and agony status were excluded. Delirium screening was performed on admission and weekly with the MDAS scale. The possible risk factors, treatment and reversibility of the episode during the week after its detection were assessed.

Results: We included 90 of the 124 oncology patients who were hospitalized during the study period. The prevalence of delirium was 75%, 29% of the cases were diagnosed on admission, and 71% were diagnosed during admission, with the majority subtype being hypoactive (56%). Seventy-three percent of the episodes constituted a terminal event and 27% were reversed or improved. The main precipitating factors were drugs (98.8%): opioids, steroids and benzodiazepines; followed by infections (46%) and dehydration (28%). The main predisposing factor was a history of depression/anxiety/insomnia (72%).

Hypercalcaemia was more frequent in patients with reversible delirium (P=.04). The primary treatment was hydration (69%), followed by a reduction of drugs, antibiotics and rotation of opioids, which is more common in patients admitted in delirium (P=.003). The main drugs administered were haloperidol (81%), midazolam (81%) and levomepromazine (54%); the latter two drugs more frequently in patients who died in delirium. Exitus occurred in 95.5% of patients with delirium compared to 65% of patients without delirium (p <0.001), with no difference in either group in the length of stay.

Conclusions: Delirium is a prevalent symptom in oncology patients hospitalized in a PCU and its main risk factors are drugs. The episode is more frequently resolved in patients with hypercalcaemia. The reversibility in our sample was lower than in other series, possibly due to the high percentage of patients diagnosed with delirium on admission and who died during the same episode.

Keywords: Delirium, Palliative care, Neoplasm, Risk factors, Memorial Delirium Assessment Scale (MDAS)

New comment

Security code:
CAPTCHA code image
Speak the codeChange the code
 


Comments

No comments in this article
© 2024 Medicina Paliativa
ISSN: 1134-248X   e-ISSN: 2340-3292

       Indexada en:
Política de Privacidad