Introduction
Delirium in the intensive care unit (ICU) is associated with increased risk of dementia,
institutionalization following hospital discharge, and increased risk of death in
patients older than 65. While recent efforts have been made to prevent delirium, any
change in delirium incidence has not been described. The aim of this study was to
determine the longitudinal incidence and prevalence of ICU delirium.
Methods
Data was obtained from participants enrolled in a randomized clinical trial testing
the effectiveness of a multicomponent delirium reduction strategy (PMD trial). They
were admitted to the medical-surgical ICU at an urban, academic-affiliated hospital
between May 2009 and January 2014. Twice daily sedation and delirium assessments were
performed using the Richmond Agitation Scale Score (RASS), and Confusion Assessment
Method for the Intensive Care Unit (CAM-ICU), respectively. Demographic and clinical
data was obtained from the study and the Regenstrief Medical Record System (RMRS).
A mixed effects logistic regression model was used to determine longitudinal trends
in incident and prevalent delirium, and odds of delirium were reported with 2014 as
reference year.
Results
In this study, 3381 patients were included. The mean age of the study sample was 57.7
years (SD 16.0), with 33% (n=1114) over the age of 65. The overall prevalence of delirium
was 19.6% (n=663), and overall incidence was 28.1% (n=209). Delirium prevalence and
incidence decreased yearly. The odds ratio for delirium prevalence was 3.32 in 2009
(95% CI 2.13-5.16, p<0.0001) which decreased to 3.17 in 2011 (95% CI 2.10-4.79, p<0.0001)
and 2.21 in 2013 (95% CI 1.42-3.46, p=0.0001). A similar decreasing trend was seen
for delirium incidence where the odds ratio in 2009 was 5.56 (95% CI 2.77-11.52, p<0.0001)
and 3.85 in 2011 (95% CI 2.02-7.33, p<0.0001). While this trend was maintained in
2012 and 2013, the yearly decrease in odds ratios for delirium incidence was not statistically
significant (2012 OR= 2.03, 95% CI 1.00-4.09, p=0.048; 2013 OR = 1.71, 95% CI 0.82-3.57,
p=0.152).
Conclusions
We found a longitudinal decrease in delirium incidence and prevalence observed in
this study. Further research is needed to analyze whether this decrease may be associated
with implementation of bundled care programs to prevent delirium, especially in elderly
adults who are at greater risk of complications following delirium.
This research was funded by
MB is supported by NIA R01 AG040220-05, AHRQ P30 HS024384-02, CMS 1 L1 CMS331444-02-00
and NIA R01 AG030618-05A1. BK is supported by NIA K23-AG043476.
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Copyright
© 2019 Published by Elsevier Inc.
