JMIR Publications

ABSTRACT

Background:

Delirium, an acute confusional state highlighted by inattention, has been demonstrated to occur in 10 to 50% of COVID-19 patients. Recognizing delirium as a possible presenting symptom of COVID-19 by using information in Electronic Health Record (EHR) data may lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and healthcare systems cost per patient.

Objective:

The specific aim of this research was to investigate the use of i2b2 as a tool to identify delirium as a presenting symptom during COVID-19.

Methods:

We used i2b2 to identify our sample. We included all COVID-19 positive adults (18 years and older) who presented to the emergency department and were subsequently admitted to our academic health system in central Florida between April 1, 2020, and April 1, 2022. The obtained data was used to produce descriptive statistics, including frequencies and percentages. We examined the data by individual diagnoses, as well as within time intervals corresponding to the national peaks of the alpha (3/27/2021 – 6/12/2021), delta (7/3/2021 – 9/30/2021), and omicron (12/1/2021 – 4/1/2022) variants. We identified delirium or encephalopathy by using the following ICD-10 codes: R41.0, R41.82, R41.9, F05, F44.89 for delirium and G92, G92.8, G92.9, G93.40, G93.41, F93.49 for encephalopathy.

Results:

A total of 4828 patients were hospitalized with COVID-19 through the ED during the study period. Slightly less than one-third of COVID-19 patients were diagnosed with a co-occurring neurocognitive disorder, (i.e., delirium or encephalopathy, n = 1,437; 29.8%). Among patients with both COVID-19 and a neurocognitive disorder, 56.9% were 65 years or older, a significantly higher proportion than those with no neurocognitive disorder. There was also a significantly higher proportion of male patients in this group, compared to those with no neurocognitive disorder. Just under a third of patients with both COVID-19 and a neurocognitive disorder expired during their hospital stay, which is a significantly higher proportion than among those with COVID-19 and no neurocognitive disorder. The length of stay in this group was also substantially higher (20.8 days). Statistically significant differences in outcomes were identified across types of neurocognitive disorders and at different COVID-19 variant peaks.

Conclusions:

Identifying delirium as a presenting sign of COVID-19 may be beneficial to better develop care plans for patients and resource planning for hospitals. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as shown, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making.