A new study suggests patients with coronavirus — particularly those over 65 — may present to healthcare settings with only symptoms of delirium rather than well-known signs of the virus like fever and shortness of breath.
New research published Thursday in JAMA Network Open found of 817 patients 65 years and older who tested positive for coronavirus and presented to the emergency department, 28% had delirium. Among those patients, 16% had delirium as a primary symptom and 37% had no typical signs of COVID-19.
Delirium is a confused state that presents as rapid change in someone's behavior such as sudden disorientation and inattention. Delirium is more common among older adults and frequently goes undetected. Research has shown that delirium can lead to worse health outcomes for patients such as mortality and longer hospital stays.
The Centers for Disease Control and Prevention currently considers delirium a warning sign of COVID-19 but it's not listed as a symptom on its website. Considering the findings of this study and another published in August with younger patients, the CDC should add delirium to its list of symptoms, said Dr. Maura Kennedy, co-lead author of the study and division chief of geriatric emergency medicine at Massachusetts General Hospital in Boston.
"Regardless of age, it's a potential symptom," she said.
By recognizing delirium as a symptom for COVID-19, it may prevent situations in which COVID-19 goes undetected. Kennedy said situations can occur where a patient isn't tested for COVID-19 because delirium is the only symptom they are having and they are then sent home or to their long-term care facility, potentially infecting others. It's also helpful information for caregivers who experience a family member displaying signs of delirium. "It may be a symptom for COVID-19 and that person does need medical care," she said.
The study also found patients with COVID-19 and delirium had worse health outcomes than the patients 65 and older with COVID-19 but without delirium. Of the 226 patients with delirium, 34% had an intensive care unit stay while 26% of the other patients with COVID-19 did. Further, 37% of those with delirium and COVID-19 died in the hospital while 29% of those without delirium died in the hospital.
Kennedy said having this information can help caregivers speak to families about patients' chances of survival.
The study used medical record data from seven ED sites from the northeast, Midwest and the south. The authors identified delirium by reviewing patient notes, codes and delirium screening tools. Because delirium is said to go undetected in two-thirds of cases, it's probable the cases of delirium were higher than the study found, Kennedy said.