Multidimensional Radiological Assessment of Delirium in the Emergency Department
Abstract
1. Introduction
2. Methods
2.1. Purpose of the Study
2.2. Inclusion Criteria
2.3. Study Design
2.4. Outcomes
2.5. Radiological Variables
- Cardiovascular calcifications;
- Body composition (visceral and abdominal fat);
- Psoas muscle volume (as an estimate of sarcopenia/cachexia).
2.6. Statistical Analysis
3. Results
3.1. Population Characteristics
3.2. Etiological Subgroups
- Septic Delirium (n = 9): Mean age 84 ± 3 years; 11.1% female. Hypoactive in 44.4%, hyperactive in 55.6%. Mean SBP 128 ± 17 mmHg, DBP 75 ± 10 mmHg, HR 93 ± 10 bpm. Charlson Index: 8 ± 3. One-year mortality: 33.3% (n = 3).
- Neurological Delirium (n = 10): Mean age 86 ± 5 years; 50% female. Hypoactive 60%, hyperactive 40%. SBP 127 ± 25 mmHg, DBP 71 ± 13 mmHg, HR 83 ± 18 bpm. Charlson Index: 7 ± 3. One-year mortality: 70% (n = 7).
- Cardiac–hypoxic Delirium (n = 6): Mean age 83 ± 7 years; 50% female. Hypoactive and hyperactive equally distributed (50%). SBP 151 ± 39 mmHg, DBP 86 ± 18 mmHg, HR 89 ± 7 bpm. Charlson Index: 6 ± 1. One-year mortality: 50% (n = 3).
- Metabolic Delirium (n = 5): Mean age 87 ± 4 years; 80% female. Hypoactive 60%, hyperactive 40%. SBP 153 ± 21 mmHg, DBP 79 ± 12 mmHg, HR 83 ± 4 bpm. Charlson Index: 7 ± 2. One-year mortality: 40% (n = 2).
3.3. Clinical History and Outcomes
- 30-day: 7% (n = 2);
- 3-month: 13% (n = 4);
- 6-month: 40% (n = 12);
- 1-year: 50% (n = 15).
3.4. Hyperactive vs. Hypoactive Delirium
3.5. Radiological Parameters and Mortality
3.6. Delirium Score and ROC Analysis
- Cachexia: 3 points;
- Vascular aging: 3 points;
- Etiology of delirium: 2 points;
- Delirium type: 1 point;
- Brain atrophy: 1 point.
4. Discussion
4.1. Delirium Etiologies and Mortality
4.2. Hyperactive vs. Hypoactive Delirium
4.3. Radiological Features as Prognostic Indicators
4.4. The Delirium Score: Improving Mortality Prediction
4.5. Clinical Implications
4.6. Study Limitations
4.7. Future Perspectives
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Number of patients, N | 30 |
Average age, years ± SD | 85 ± 5 |
Female sex, n/N (%) | 13 (43.3) |
Delirium etiology | |
Cardiac/hypoxic, n/N (%) | 6 (20%) |
Septic, n/N (%) | 9 (30%) |
Neurological, n/N (%) | 10 (33.3%) |
Metabolic, n/N (%) | 5 (16.7%) |
Delirium type | |
Hypoactive, n/N (%) | 16 (53.3%) |
Hyperactive, n/N (%) | 14 (46.7%) |
Systolic BP, mmHg ± SD | 136 ± 27 |
Diastolic BP, mmHg ± SD | 77 ± 14 |
Heart rate, bpm ± SD | 88 ± 13 |
Charlson Comorbidity Index, N ± SD | 7 ± 2 |
Cognitive decline history, n/N (%) | 12 (40%) |
Disability, n/N (%) | 16 (53.3%) |
Anemia history, n/N (%) | 10 (33.3%) |
Electrolyte abnormalities, n/N (%) | 8 (26.7%) |
Length of stay, days ± SD | 18 ± 15 |
Mortality | |
30-day mortality, n/N (%) | 2 (7%) |
3-month mortality, n/N (%) | 7 (13%) |
6-month mortality, n/N (%) | 12 (40%) |
1-year mortality, n/N (%) | 15 (50%) |
Septic (1) | Neurological (2) | Cardiac–Hypoxic (3) | Metabolic (4) | |
---|---|---|---|---|
Number of patients, N | 9 | 10 | 6 | 5 |
Average age, years ± SD | 84 ± 3 | 86 ± 5 | 83 ± 7 | 87 ± 4 |
Female sex, n/N | 1 | 5 | 3 | 4 |
Hypoactive, n/N | 4 | 6 | 3 | 3 |
Hyperactive, n/N | 5 | 4 | 3 | 2 |
Systolic BP, mmHg ± SD | 128 ± 17 | 127 ± 25 | 151 ± 39 | 153 ± 21 |
Diastolic BP, mmHg ± SD | 75 ± 10 | 71 ± 13 | 86 ± 18 | 79 ± 12 |
Heart rate, bpm ± SD | 93 ± 10 | 83 ± 18 | 89 ± 7 | 83 ± 4 |
Charlson Comorbidity Index, N ± SD | 8 ± 3 | 7 ± 3 | 6 ± 1 | 7 ± 2 |
Cognitive decline history, n/N | 3 | 4 | 4 | 1 |
Disability, n/N | 6 | 5 | 3 | 2 |
Anemia, n/N | 3 | 6 | 0 | 1 |
Electrolyte abnormalities, n/N | 0 | 2 | 2 | 4 |
Length of stay, days ± SD | 23 ± 13 | 20 ± 18 | 16 ± 14 | 7 ± 3 |
1-year mortality, n/N (%) | 3 (33.3%) | 7 (70%) | 3 (50%) | 2 (40%) |
Hyperactive | Hypoactive | p-Value | |
---|---|---|---|
Average age, years ± SD | 86 ± 3 | 84 ± 6 | ns |
Female sex, n/N | 6 | 7 | ns |
Septic, n/N | 5 | 4 | ns |
Neurological, n/N | 4 | 6 | ns |
Cardiac hypoxic, n/N | 3 | 3 | ns |
Metabolic, n/N | 2 | 3 | ns |
Systolic BP, mmHg ± SD | 139 ± 31 | 134 ± 24 | ns |
Diastolic BP, mmHg ± SD | 79 ± 15 | 75 ± 13 | ns |
Charlson Comorbidity Index, N ± SD | 6 ± 2 | 8 ± 2 | 0.07 |
Estimated 10-year survival, % | 25 | 6 | 0.013 |
Cognitive decline history, n/N (%) | 4 (33.3%) | 8 (66.7%) | ns |
Disability, n/N | 7 | 9 | ns |
Anemia, n/N | 6 | 4 | ns |
Electrolyte abnormalities, n/N | 3 | 5 | ns |
Length of stay, days ± SD | 17 ± 13 | 18 ± 16 | ns |
1-year mortality, n/N (%) | 6 (43%) | 8 (50%) | ns |
Radiological Variables | Deceased | Living | All | p-Value |
---|---|---|---|---|
Number of patients, N | 15 | 15 | 30 | - |
Average age, years ± SD | 85 ± 5 | 84 ± 4 | 85 ± 5 | ns |
Common trunk calcifications, median (IQR) | 0 (0.02)) | 0 (0) | 0(0) | ns |
Anterior descending calcifications, median (IQR) | 100 (259) | 79 (313) | 87 (290) | ns |
Circumflex calcifications, median (IQR) | 2 (72) | 0 (18) | 0.75 (27) | ns |
Right coronary calcifications, median (IQR) | 76 (418) | 0 (12) | 3.7 (215) | ns |
Total calcium score, median (IQR) | 300 (711) | 100 (724) | 192 (838) | ns |
Aortic valve calcifications, median (IQR) | 0 (71) | 0 (0) | 0 (35) | ns |
Abdominal fat percentage, % median (IQR) | 30 (7) | 37 (15) | 33 (10) | 0.06 |
Visceral abdominal fat, % median (IQR) | 30 (10) | 35 (18.5) | 32 (19) | ns |
Psoas volume, mm3 ± SD, median (IQR) | 150 (40) | 200 (41.5) | 199 (62) | 0.02 |
Vascular age, years ± SD | 83 ± 23 | 72 ± 16 | 78 ± 20 | ns |
Cachexia, n/N (%) | 10 (66.6%) | 3 (20%) | 13 (76%) | 0.025 |
Vascular elder, n/N (%) | 11 (73%) | 4 (26.6%) | 15 (50%) | 0.027 |
Brain atrophy, n/N (%) | 10 (66.6%) | 7 (46%) | 17 (56.6%) | ns |
Length of stay, days ± SD | 19 ± 17 | 11 ± 15 | 18 ± 15 | ns |
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Cereda, A.F.; Frangi, C.; Rocchetti, M.; Spangaro, A.; Tua, L.; Franchina, A.G.; Carlà, M.; Colavolpe, L.; Carelli, M.; Palmisano, A.; et al. Multidimensional Radiological Assessment of Delirium in the Emergency Department. Healthcare 2025, 13, 1871. https://doi.org/10.3390/healthcare13151871
Cereda AF, Frangi C, Rocchetti M, Spangaro A, Tua L, Franchina AG, Carlà M, Colavolpe L, Carelli M, Palmisano A, et al. Multidimensional Radiological Assessment of Delirium in the Emergency Department. Healthcare. 2025; 13(15):1871. https://doi.org/10.3390/healthcare13151871
Chicago/Turabian StyleCereda, Alberto Francesco, Claudia Frangi, Matteo Rocchetti, Andrea Spangaro, Lorenzo Tua, Antonio Gabriele Franchina, Matteo Carlà, Lucia Colavolpe, Matteo Carelli, Anna Palmisano, and et al. 2025. "Multidimensional Radiological Assessment of Delirium in the Emergency Department" Healthcare 13, no. 15: 1871. https://doi.org/10.3390/healthcare13151871
APA StyleCereda, A. F., Frangi, C., Rocchetti, M., Spangaro, A., Tua, L., Franchina, A. G., Carlà, M., Colavolpe, L., Carelli, M., Palmisano, A., Etteri, M., & Lucreziotti, S. (2025). Multidimensional Radiological Assessment of Delirium in the Emergency Department. Healthcare, 13(15), 1871. https://doi.org/10.3390/healthcare13151871