811 DELIRIUM IN COVID-19: COMMON AND CLINICALLY SIGNIFICANT: EXPERIENCES FROM THE NIGHTINGALE HOSPITAL EXETER

Abstract

BackgroundDelirium is an independent predictor of mortality in patients admitted with community-acquired pneumonia (Pieralli, 2014), but significance and incidence in Covid-19 infection has not been established. The Nightingale Hospital Exeter (NHE) as a multidisciplinary team model, managed 242 patients with Covid-19 from November 2020 to February 2021. This study identifies the delirium incidence, outcome, premorbid function and demographics of this cohort.MethodsElectronic records were retrospectively reviewed for keywords ‘Delirium’, ‘Hyperactive’, ‘Hypoactive’, ‘Confused’ and ‘Muddled’. Patients were categorised as Hyperactive, Hypoactive or Confused/non-specified. Prior functional support (independent, package of care, residential or nursing care) and presence of pre-established neurological conditions (including dementia) were noted.Results242 patients were included, average age 84 years (range 59–102). Of these patients, 130 (54%) developed delirium (29 (22%) hyperactive, 37 (28%) hypoactive, 2 (1%) mixed and 62 (48%) ‘confused’/non-specified). Of those with delirium, 56 (43%) were previously living independently and 51 (39%) were living at home with a package of care. 60 (46%) of those diagnosed had no pre-existing neurological condition, 32% had underlying dementia. There were 37 deaths at NHE (mortality 15%), 73% of these patients had delirium during their admission compared to 50% of those who survived.ConclusionsOver half this cohort developed delirium, a high proportion of whom had been living independently prior to admission with no pre-existing neurological condition, emphasising how common delirium is in patients with Covid-19. In a comparable cohort with pneumonia (mean age 82 years, range 65–99) 25% developed delirium, and it was an independent predictor of in-hospital mortality (Pieralli, 2014). The fact that 73% of all patients who died developed delirium suggests it may have important prognostic implications, and both this and the high incidence indicate further work is required to fully understand how to prevent and manage delirium in Covid-19.