Encephalopathy vs Delirium 🧠: 1/11
#COVID19 has profoundly amped this malady for millions...
ICU Doc asked: “Wes, what’s the difference between delirium & encephalopathy?” I chuckled, “Got an hour?” & distilled it down in 2 min.
#medtwitter #pulmcc #meded #tipsfornewdocs
#COVID19 has profoundly amped this malady for millions...
ICU Doc asked: “Wes, what’s the difference between delirium & encephalopathy?” I chuckled, “Got an hour?” & distilled it down in 2 min.
#medtwitter #pulmcc #meded #tipsfornewdocs
Encephalopathy vs Delirium: 2/
20 years ago we started publishing our ICU Delirium papers. The biggy was in JAMA after being rejected by NEJM’s main Neurologist Reviewer because “we used the term delirium & not encephalopathy.”
So this confusion is STILL going on…
20 years ago we started publishing our ICU Delirium papers. The biggy was in JAMA after being rejected by NEJM’s main Neurologist Reviewer because “we used the term delirium & not encephalopathy.”
So this confusion is STILL going on…
Encephalopathy vs Delirium: 3/
To help with this nomenclature problem, Arjen Slooter led us & we published this 2020 delphi study and paper endorsed by 10 med societies.
Intens Care Med:
bit.ly/3eLODWJ
#medtwitter #medstudenttwitter #pulmcc #tipsfornewdocs
To help with this nomenclature problem, Arjen Slooter led us & we published this 2020 delphi study and paper endorsed by 10 med societies.
Intens Care Med:
bit.ly/3eLODWJ
#medtwitter #medstudenttwitter #pulmcc #tipsfornewdocs
Encephalopathy vs Delirium: 4/
Bottom Line:
Use delirium & encephalopathy interchangeably ONLY for “quiet” delirium. Add Coma & you have major spectrum of acute brain dysfunction in #ICU & hospitalized “confused pts.”
Bottom Line:
Use delirium & encephalopathy interchangeably ONLY for “quiet” delirium. Add Coma & you have major spectrum of acute brain dysfunction in #ICU & hospitalized “confused pts.”
Encephalopathy vs Delirium: 5/
Delirium is a broader term than encephalopathy & includes BOTH hyperactive & hypoactive acute brain dysfunction.
EG:
CAM-ICU positive w/ high RASS is hyperactive delirium.
CAM-ICU positive w/ normal or low RASS score is hyooactive delirium.
Delirium is a broader term than encephalopathy & includes BOTH hyperactive & hypoactive acute brain dysfunction.
EG:
CAM-ICU positive w/ high RASS is hyperactive delirium.
CAM-ICU positive w/ normal or low RASS score is hyooactive delirium.
Encephalopathy vs Delirium: 6/
Hyperactive Delirium =
🤔 DTs. Agitation. 90% “withdrawal” from drugs like Alcohol, Benzos, & Narcotics
Hypoactive delirium = Encephalopathy. It’s QUIET delirium, manifested by an ABSENCE of symptoms & analogous to a petit mal seizure.
Hyperactive Delirium =
🤔 DTs. Agitation. 90% “withdrawal” from drugs like Alcohol, Benzos, & Narcotics
Hypoactive delirium = Encephalopathy. It’s QUIET delirium, manifested by an ABSENCE of symptoms & analogous to a petit mal seizure.
Encephalopathy vs Delirium: 7/
Interesting History:
<1% of papers use BOTH terms delirium & encephalopathy in same study. 99% pick one or other. Neurology literature pushes “encephalopathy” for hypoactive delirium & “delirium” just for hyperactive state = TERMINOLOGY SPLITTERS
Interesting History:
<1% of papers use BOTH terms delirium & encephalopathy in same study. 99% pick one or other. Neurology literature pushes “encephalopathy” for hypoactive delirium & “delirium” just for hyperactive state = TERMINOLOGY SPLITTERS
Encephalopathy vs Delirium: 8/
As opposed to neurology, the geriatric & psychiatry literature uses delirium for BOTH hypoactive and hyperactive forms of acute brain dysfunction. They are TERMINOLOGY LUMPERS.
There you have it!
As opposed to neurology, the geriatric & psychiatry literature uses delirium for BOTH hypoactive and hyperactive forms of acute brain dysfunction. They are TERMINOLOGY LUMPERS.
There you have it!
Encephalopathy vs Delirium: 9/
BILLING: One thing driving the ongoing use of “encephalopathy” is that ICD-9 CODING is more geared to that term than to “delirium.” Delirium coding is a work in progress. So as usual, 💰is at the heart of much.
BILLING: One thing driving the ongoing use of “encephalopathy” is that ICD-9 CODING is more geared to that term than to “delirium.” Delirium coding is a work in progress. So as usual, 💰is at the heart of much.
Encephalopathy vs Delirium: 10/
The problem with using “encephalopathy” for hypoactive states is that ALL valid & reliable delirium tools (eg, 4-AT) call someone “delirious” at BOTH hyper- & hypoactive states of acute brain dysfunction. So documentation gets tricky/messed up.
The problem with using “encephalopathy” for hypoactive states is that ALL valid & reliable delirium tools (eg, 4-AT) call someone “delirious” at BOTH hyper- & hypoactive states of acute brain dysfunction. So documentation gets tricky/messed up.
Encephalopathy vs Delirium: 11/Fin
BONUS: Delirium duration is a predictor of what 4 relevant outcomes?
1. Death
2. Length of stay
3. Cost of Care
4. Acquired dementia
Friends, this matter! Monitor patients for #delirium. Talk & fix it on rounds via Dr. Dre & A2Fbundle
BONUS: Delirium duration is a predictor of what 4 relevant outcomes?
1. Death
2. Length of stay
3. Cost of Care
4. Acquired dementia
Friends, this matter! Monitor patients for #delirium. Talk & fix it on rounds via Dr. Dre & A2Fbundle
Another way of looking at this question/topic of whether pts have delirium or encephalopathy & are these words interchangeable?
Delirium= clinical phenotype
Encephalopathy= patholophysiology / cause
see paper by @MarkOldhamMD
bit.ly/30XJwQh
Delirium= clinical phenotype
Encephalopathy= patholophysiology / cause
see paper by @MarkOldhamMD
bit.ly/30XJwQh
