Abstract
Objective: To study the frequency of neurological diagnostic testing (NDT) and hospital length of stay (LOS) in elderly patients with altered mental status (AMS).
Background: Acute AMS or delirium is a frequent cause or complication of hospitalization in elderly patients. In many cases, it is followed by accelerated cognitive and functional decline leading to higher rates of institutionalization. The common causes of delirium in the elderly are high-risk sedative/psychotropic medication use, systemic infections, and metabolic derangements. These patients often undergo low-yield NDT, including neuroimaging, electroencephalography (EEG) and less frequently cerebrospinal fluid analysis resulting in longer LOS and higher healthcare costs. We studied the etiology, utilization of NDT and LOS in elderly patients with acute AMS.
Design/Methods: We collected retrospective data on consecutive patients aged ≥60 years evaluated by the Neurohospitalist Service for acute AMS between 2016–2018 at a tertiary care hospital. The variables assessed included patient demographics, frequency of NDT, etiology of acute AMS based on clinical assessment and ancillary testing, and LOS.
Results: In 96 patients studied (mean age 72±8 years, 58% men), acute AMS was related to toxic/metabolic/infectious causes in 75% of cases. Neuroimaging was obtained in almost all cases (head CT scan in 97% and/or brain MRI in 51%), routine EEG in 52% and continuous EEG monitoring in 10%. Lumbar puncture was performed in 11% cases. The average LOS was 21±SD 24 days and median was 12 days (range 1–131).
Conclusions: There was a high rate of NDT in acute AMS consults for elderly patients despite the primary etiology being toxic/metabolic/infectious in the majority of cases. The overutilization of NDT likely contributed to longer LOS. Our data highlight the need to implement a risk-stratification-based standardized clinical care pathway for optimal utilization of NDT in elderly patients with AMS. This may help minimize low-yield testing and reduce LOS.
Disclosure: Dr. Lau has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Bailey has nothing to disclose. Dr. Lukas has nothing to disclose. Dr. Mayberry has nothing to disclose. Dr. Feldman has nothing to disclose. Dr. Garg has nothing to disclose.
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