Delirium was common among elderly patients with Covid-19 who came to the emergency department, according to a study published Thursday in JAMA Network Open, and many of them did not have other typical signs or symptoms of the disease.
“In this multicenter retrospective cohort study, 28% of 817 older patients with Covid-19 infection had delirium on arrival to the ED, and delirium was the sixth most common presenting symptom or sign overall,” read the study, from lead authors Dr. Maura Kennedy of Massachusetts General Hospital and Harvard Medical School and Benjamin Helfand of the University of Massachusetts Medical School.
“Delirium at presentation was significantly associated with increased risk for poor hospital outcomes, including ICU stay, discharge to a rehabilitation facility, and death," the study said.
Of the 226 patients with delirium, 37, or 16%, had delirium as their primary symptom. Importantly, the authors said, 84 of those 226, or 37%, had no fever or shortness of breath.
More on the study: The study was conducted at seven sites across the United States and included older adults who went to emergency departments on or after March 13.
Some of the factors associated with delirium included being older than 75, living in a nursing home or assisted living facility, prior use of psychoactive medication, vision or hearing impairment, stroke and Parkinson’s disease.
“Our study demonstrates that it is critical to recognize that older adults with Covid-19 may present with delirium as the primary or sole symptom,” the study says. “In addition, delirium is an important risk marker to identify patients at high risk for poor outcomes, including death.”
Remember: The study does have some limitations, including the fact that they suspect that the delirium rate observed is an underestimate, they were unable to evaluate site-specific data and enrollment occurred primarily in the Northeast during a time when it was undergoing a surge in Covid-19 infections.