Time trends of delirium rates in the intensive care unit

Sikandar H Khan; Heidi Lindroth; Kyle Hendrie; Sophia Wang; Sundus Imran; Anthony J Perkins; Sujuan Gao; Farhaan S Vahidy; Malaz Boustani; Babar A Khan

doi:10.1016/j.hrtlng.2020.03.006

Time trends of delirium rates in the intensive care unit

Heart Lung. 2020 Sep-Oct;49(5):572-577. doi: 10.1016/j.hrtlng.2020.03.006. Epub 2020 Mar 25.

Authors

Sikandar H Khan¹, Heidi Lindroth², Kyle Hendrie³, Sophia Wang⁴, Sundus Imran⁵, Anthony J Perkins⁶, Sujuan Gao⁷, Farhaan S Vahidy⁸, Malaz Boustani⁹, Babar A Khan¹⁰

Affiliations

¹ Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA. Electronic address: sikhan@iu.edu.
² Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA. Electronic address: hlindrot@iu.edu.
³ IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA. Electronic address: khendrie668@marian.edu.
⁴ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA. Electronic address: sophwang@iu.edu.
⁵ IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA. Electronic address: sunimran@iu.edu.
⁶ Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: antperki@iupui.edu.
⁷ Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: sgao@iu.edu.
⁸ Institute for Stroke and Cerebrovascular Diseases and the Department of Neurology at University of Texas Health Science Center at Houston, Texas, USA. Electronic address: Farhaan.Vahidy@uth.tmc.edu.
⁹ IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, Indiana, USA; Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: mboustan@iu.edu.
¹⁰ Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, Indiana, USA. Electronic address: bakhan@iu.edu.

Abstract

Background: Effects of clinical practice changes on ICU delirium are not well understood.

Objectives: Determine ICU delirium rates over time.

Methods: Data from a previously described screening cohort of the Pharmacological Management of Delirium trial was analyzed. Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) were assessed twice daily. We defined: Any delirium (positive CAM-ICU at any time during ICU stay) and ICU-acquired delirium (1st CAM-ICU negative with a subsequent positive CAM-ICU). Mixed-effects logistic regression models were used to test for differences.

Results: 2742 patient admissions were included. Delirium occurred in 16.5%, any delirium decreased [22.7% to 10.2% (p < 0.01)], and ICU-acquired delirium decreased [8.4% to 4.4% (p = 0.01)]. Coma decreased from 24% to 17.4% (p = 0.04). Later ICU years and higher mean RASS scores were associated with lower odds of delirium.

Conclusions: Delirium rates were not explained by the measured variables and further prospective research is needed.

Keywords: Delirium; Intensive care unit; Outcomes; Time trend.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Cohort Studies
Coma
Delirium* / diagnosis
Delirium* / epidemiology
Humans
Intensive Care Units
Mass Screening

Abstract

Publication types

MeSH terms

Grants and funding