Structural brain lesions and delirium in geriatric emergency department patients: A matched case-control study

Dylan A. Glawe; Anthony Marincovich; Taeuk Kang; Eric Kontowicz; Matthew Howard; Sangil Lee

doi:10.1016/j.ajem.2026.05.028

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Structural brain lesions and delirium in geriatric emergency department patients: A matched case-control study

Journal article

Peer reviewed

Structural brain lesions and delirium in geriatric emergency department patients: A matched case-control study

Dylan A. Glawe, Anthony Marincovich, Taeuk Kang, Eric Kontowicz, Matthew Howard and Sangil Lee

The American journal of emergency medicine, Vol.107, pp.88-93

09/2026

DOI: 10.1016/j.ajem.2026.05.028

PMID: 42190635

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Abstract

Background Delirium affects up to one-third of older adults in the emergency department (ED) and is frequently underrecognized. Head CT obtained during ED evaluation may reveal structural brain abnormalities in this population. This study evaluated whether structural lesions identified on head CT are associated with delirium in older ED patients. Methods We conducted a retrospective matched case-control study of adults aged ≥65 years who underwent delirium screening and head CT within 24 h of ED arrival. Delirium was defined by a positive Delirium Triage Screen followed by a positive Brief Confusion Assessment Method. Cases were matched 1:1 to non-delirious controls by age, sex, Emergency Severity Index, and chief complaint. Structural lesions were identified through radiology report review. Conditional logistic regression estimated associations between lesion presence and delirium, adjusting for pre-existing dementia and comorbidity. Results A total of 244 patients were included (122 delirium cases and 122 matched controls). Structural brain lesions were present in 55.7% of delirium cases compared with 37.7% of controls. The presence of any structural brain lesion was associated with higher odds of delirium (unadjusted OR = 2.2, 95% CI: 1.3–3.7; adjusted OR = 2.1, 95% CI: 1.1–3.8). Ischemic lesions were the most frequently identified abnormality. Conclusions Structural brain lesions on head CT were associated with higher odds of delirium among older ED patients. When clinically indicated, imaging findings may complement bedside screening and known risk factors but do not establish additional diagnostic value beyond standard delirium assessment.

Delirium

Geriatrics

Older adult

Brain lesions

Emergency department

Details

Title: Subtitle: Structural brain lesions and delirium in geriatric emergency department patients: A matched case-control study
Creators: Dylan A. Glawe - University of Iowa
Anthony Marincovich - University of Iowa
Taeuk Kang - University of Iowa
Eric Kontowicz - University of Iowa
Matthew Howard - University of Iowa
Sangil Lee - University of Iowa
Resource Type: Journal article
Publication Details: The American journal of emergency medicine, Vol.107, pp.88-93
DOI: 10.1016/j.ajem.2026.05.028
PMID: 42190635
NLM abbreviation: Am J Emerg Med
ISSN: 0735-6757
eISSN: 1532-8171
Publisher: Elsevier
Grant note: University of Iowa Carver College of Medicine Office of the Dean through the Iowa Medical Student Research Program Summer Research Fellowship
Funding This work was supported by University of Iowa Carver College of Medicine Office of the Dean through the Iowa Medical Student Research Program Summer Research Fellowship.
Language: English
Electronic publication date: 05/2026
Date published: 09/2026
Academic Unit: Neurology; Anatomy and Cell Biology; Epidemiology; Emergency Medicine; Iowa Neuroscience Institute; Injury Prevention Research Center; Neurosurgery; Otolaryngology
Record Identifier: 9985164721602771

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