Don't call me crazy! Delirium occurs outside of the intensive care unit.

Abstract

INTRODUCTION:

Delirium has been well studied among patients in the intensive care unit (ICU); however, data beyond the ICU is limited. The purpose of this study is to prospectively evaluate the incidence and associated risk factors for delirium in noncritical care areas (NCCA).

METHODS:

After institutional review board approval, a prospective cohort study was conducted at our urban Level I Trauma Center from December 2015 to February 2016. All patients admitted to the designated study area by a trauma surgeon were included. The Confusion Assessment Method (CAM) was administered every 12 hours until discharge. Delirious patients (CAM+) were administered the CAM-S to quantify the severity of delirium. Demographics, laboratory data, and inpatient medication lists were analyzed.

RESULTS:

Of 148 participants, 12 (8%) were CAM+ and 136 (92%) were CAM-. The average CAM-S of CAM+ patients was 7 ± 3. Included patients were aged 52 ± 20 years and 45% were men. Of patients 65 years or older, 9 (21%) were CAM+. Medications associated with delirium were: albuterol (p = 0.01), atorvastatin (p = 0.01), duloxetine (p = 0.04), sertraline (p = 0.04), folic acid (p = 0.01), thiamine (p = 0.01), vitamin D (p < 0.001), haloperidol (p = 0.04), metoprolol (p = 0.02), and vancomycin (p = 0.02). Abnormal laboratory values associated with delirium included: Albumin (p = 0.03; odds ratio [OR], 7.94, 95% confidence interval [CI], 1.1-63.20), Calcium (p = 0.01; OR, 4.95; 95% CI, 1.5-16.7), Sodium (p = 0.04; OR, 3.91; 95% CI, 1.13-13.5), hematocrit (p = 0.04), and mean corpuscular hemoglobin concentration (p < 0.05; OR, 5.29; 95% CI, 1.19-23.46).

CONCLUSIONS:

Our study demonstrated an 8% incidence of delirium overall in NCCA, increasing to 21% in patients 65 years or older. Many risk factors identified among NCCA patients are consistent with the ICU literature; however, our CAM+ patients had additional risk factors which have not been previously associated with the development of delirium. Screening of NCCA patients for delirium should be considered.

LEVEL OF EVIDENCE:

Prognostic and Epidemological, level IV.

• Authors: Anthony Cahill, Christopher Pearcy, Khalid Almahmoud, Vaidehi Agrawal, Usha Mani, Phillip Sladek, Michael S Truitt
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 84 Issue 1 Pg. 66-69 (01 2018) ISSN: 2163-0763 [Electronic] United States
• PMID: 29040201 (Publication Type: Journal Article)

Topics

• Adult
• Age Factors
• Aged
• Delirium (blood, chemically induced, epidemiology)
• Female
• Hospitalization
• Humans
• Incidence
• Inpatients (psychology)
• Length of Stay
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Trauma Centers