Inpatient Rehabilitation Delirium Screening: Impact on Acute Care Transfers and Functional Outcomes.
Sharon Bushi, A M Barrett, Mooyeon Oh-Park
PMID 31840935WHAT IT FOUND
A positive delirium screen at inpatient rehab admission was linked to more transfers to acute care.
Those patients also gained less motor function and were less likely to go home.
Key findings
01A positive 3D-CAM delirium screen at admission independently predicted transfer to acute care hospitals after adjustment (OR 1.61, CI 1.03-2.53, P=.04).
02Patients with delirium had lower motor and cognitive FIM scores at discharge, gained less motor FIM (20.5 versus 26.3, P<.001), and were less often discharged home (50.6% versus 71.7%, P<.001).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was retrospective, so selection and misclassification bias are possible. Patients with a negative admission screen were not reassessed, which may have missed later delirium. The data came from one inpatient rehabilitation facility, so other settings may differ. The study excluded 159 subsequent admissions, so it says little about people admitted more than once. The study did not test whether screening or treating delirium changed outcomes. The unscorable group had higher raw transfers but was not an independent predictor, so communication barriers cannot be separated from other risks.
Declared interests
Research support is listed as NIH extramural and non-U.S. government funding. The supplied text does not include an author conflict-of-interest statement.
The easy way to misread this
Do not read this as proof that screening improves outcomes. The study observed patients already screened and did not test an intervention.