(CSEMP007) EFFECT OF ORDERING TSH LEVELS ON SUBSEQUENT CLINICAL MANAGEMENT OF INTERNAL MEDICINE IN-PATIENTS ADMITTED WITH DELIRIUM

Background: Thyroid-stimulating hormone (TSH) is commonly ordered in the investigation of delirium as thyroid dysfunction is a known cause of delirium. Previous studies have recommended against the routine testing of thyroid function in all in-patients due to low clinical yield and excess use of resources. This has not been investigated in in-patients admitted for delirium specifically. We aimed to investigate the clinical yield of thyroid function testing in in-patients admitted for delirium.

METHODS AND RESULTS:

Methods: This was a retrospective study of 84 patients admitted to hospital with delirium or an equivalent term identified as one of their in-hospital issues. Both patients with and without TSH tested in-hospital were included. The primary outcome was a composite of the proportion of patients with TSH tested who had further thyroid-related testing or medications ordered during their hospital stay. Secondary outcomes included the number and types of thyroid-related symptoms documented during admission. Descriptive statistics were used to analyze the data.

Results: TSH was ordered in 65 (77.4%) patients and the result was within the reference range in 53 (81.5%) cases. Thyroid disease was identified as the etiology of delirium in zero cases. Only 3 (4.6%) patients had additional thyroid-related testing or medications ordered. The average number of thyroid-related symptoms reported per patient was 1.095. Thirty-one (36.9%) patients had zero symptoms of thyroid disease documented.

Conclusion: Thyroid function testing does not often result in a change in clinical management in the investigation of delirium in in-patients. Routine TSH testing in delirium without thyroid-related symptoms or when another cause of delirium is apparent may use resources excessively with low clinical yield.