91 5 DELIRIUM | PART THREE Introduction Delirium is a common problem in hospital care, especially for patients with cancer as well as elderly and frail patients [1]. It is a syndrome of brain dysfunction characterized by a disturbance in attention, awareness, and cognition, with a rapid onset that is caused by an underlying medical condition [2,3]. The occurrence of delirium depends on a combination of vulnerability (predisposing factors) and precipitating factors, that trigger the development of delirium [4]. Risk factors include aging, cognitive impairment and a history of delirium, and screening for delirium in patients at risk may be of help to reduce suffering from delirium [5-11]. Data on the incidence and prevalence of delirium in literature range from a five percent prevalence rate upon admission to a geriatric hospital ward [12] up to an incidence rate of 88 percent in patients dying from cancer [8]. This diversity in incidence and prevalence rates indicates that it is a serious problem for patients with cancer especially when terminally ill. In recent publications it has been suggested that prophylactic treatment with antipsychotics should be considered to prevent delirium [13-17], but due to the varying incidence rates of delirium and the sometimes severe side-effects of these medicines (primarily haloperidol) [18] there is reluctance to apply preventive treatment to all patients with cancer admitted to the hospital. Itwouldbeof clinical significance if one coulddeterminewhichpatients are likely todevelop delirium at admission in order to select patients who might benefit from prophylactic treatment. In this study, the primary aim was to evaluate the occurrence of delirium and its risk factors in patients with cancer admitted to the hospital for treatment or palliative care in order to develop a prediction model to identify patients at high risk for delirium. Methods This retrospective study was conducted in all patients with solid malignancies admitted to our medical oncology ward of the VUmc Cancer Center Amsterdam (CCA), VU University Medical Center, between Jan 1st 2011 and June 30th 2012. For each patient the following datawere collected frommedical charts: baseline characteristics, presence of deliriumand its risk factors throughout the entire admission. The study was conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Because of the retrospective character of this study no additional informed consent could be obtained and a waiver was obtained from the medical ethical committee. Screening for delirium was performed twice a week during three consecutive nursing shifts according to standard hospital procedures using the DeliriumObservation Screening Scale (DOSS) [12]. The DOSS is a validated 13-item nurse rated screening instrument for delirium that is commonly used in Dutch hospitals. Scores range from 0 to 13 points, with
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