Written by Jason Lesnick
Spoon Feed
Older adults discharged from the ED with delirium had almost 3 times the risk of 30-day mortality compared to those discharged without delirium.
Delirium dispo double-take
This retrospective cohort study asked whether older adults discharged from the ED with delirium experience higher 30-day mortality and ED return rates.
This study included 22,940 visits of adults ≥ 75 years old from a large academic ED in Minnesota from 2021-2023. Patients were screened for delirium by nurses using the Delirium Triage Screen (DTS) and brief Confusion Assessment Method (bCAM) and were grouped into four categories: delirium positive—discharged, delirium positive—admitted, delirium negative—discharged, and delirium negative—admitted.
The authors found after multivariable adjustments, delirium positive—discharged patients had significantly increased 30-day mortality (8.4%; aRR 2.86, 95%CI 2.04–4.00) and higher ED return rates (32.2%; aRR 1.52, 95%CI 1.43–1.61) compared with delirium negative discharges.
Interestingly, 30-day mortality was highest in the delirium positive—admitted group (13.4%), followed by delirium positive—discharged group (8.4%), then delirium negative—admitted (6.0%), and delirium negative—discharged (1.5%) groups.
They also found that delirium positive—discharged patients had a significantly higher risk of ED return within 30 days compared to delirium positive patients admitted to the hospital (aRR 1.64, 95% CI 1.40 to 1.92).
How will this change my practice?
I generally only discharge patients with delirium in palliative care or very specific, complex social situations. My take on this paper is that disposition planning for every patient with delirium needs to involve multiple other people to ensure that we are doing what is best for the patient, and that we better have a great reason for discharging someone with delirium.
Source
Outcomes of Older Adults With Delirium Discharged From the Emergency Department. Ann Emerg Med. 2025 Nov;86(5):484-495. doi: 10.1016/j.annemergmed.2025.02.003. Epub 2025 Mar 12. PMID: 40072382; PMCID: PMC12353625.
View Critical Appraisal
Critical Appraisal
- Selection (3/4 stars) — Some concerns: Good representativeness but potential selection bias due to retrospective design.
- Comparability (1/2 stars) — Some concerns: Limited adjustment for confounders such as comorbidities and social factors.
- Outcome (2/3 stars) — Some concerns: Outcome assessment relies on accurate record-keeping; follow-up completeness is unclear.
