A Prospective Study of Delirium and Prolonged Hospital Stay

Thomas, Rogelio I.

doi:10.1001/archpsyc.1988.01800340065009

Cited by 213 publications

(107 citation statements)

References 22 publications

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“…Following this development, several clinical investigations found relationships between SAA levels and the development of delirium [102][103][104]. Thomas and colleagues [102] reported that SAA levels were higher in delirious patients when compared with non-delirious individuals in a sample of surgical patients in the ICU. Tune and colleagues [103] reported similar findings in postoperative cardiac patients whose MMSE scores were related to SAA levels (r ¼ 0.83; P!.001).…”

Section: The Cholinergic Hypothesismentioning

confidence: 98%

“…SAA is believed to cross the blood-brain barrier and has been linked to the depth of delirium in several studies [102][103][104]. The assay required to measure SAA was first developed in 1980 by Tune and Coyle [105].…”

Section: The Cholinergic Hypothesismentioning

confidence: 99%

“…The assay required to measure SAA was first developed in 1980 by Tune and Coyle [105]. Following this development, several clinical investigations found relationships between SAA levels and the development of delirium [102][103][104]. Thomas and colleagues [102] reported that SAA levels were higher in delirious patients when compared with non-delirious individuals in a sample of surgical patients in the ICU.…”

Section: The Cholinergic Hypothesismentioning

confidence: 99%

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Pathophysiology of Delirium in the Intensive Care Unit

Gunther

Morandi

Ely

2008

Critical Care Clinics

153

101

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Section: The Cholinergic Hypothesismentioning

confidence: 98%

Section: The Cholinergic Hypothesismentioning

confidence: 99%

Section: The Cholinergic Hypothesismentioning

confidence: 99%

See 1 more Smart Citation

Pathophysiology of Delirium in the Intensive Care Unit

Gunther

Morandi

Ely

2008

Critical Care Clinics

153

101

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“…1 It is common in both elderly medical and surgical patients 1,2 and is associated with an increase in mortality, morbidity, rate of admission to long-term care institutions, and length of hospitalization. 3,4 Delirium is often not recognized, [5][6][7] and intervention benefits to date have shown to be limited. [8][9][10] Thus, prevention through identification of a high-risk group is indicated.…”

mentioning

confidence: 99%

Delirium risk factors in elderly hospitalized patients

et al. 1998

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OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS:First, MEDLINE / CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

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“…[7][8][9][10] Delirium is associated with significantly increased morbidity, functional decline, and utilization of health care services. 1,[11][12][13][14] In patients with malignancies, delirium appears to confer an increase in mortality, with excess mortality ratios of 6.2 during hospitalization and 14.1 during 1-5 years of follow-up. 15 Despite its high prevalence and association with negative outcomes, delirium goes undiagnosed in 32-67% of patients and remains largely undertreated.…”

mentioning

confidence: 99%

Delirium in patients undergoing hematopoietic stem cell transplantation

Fann

Roth-Roemer²,

Burington

et al. 2002

Cancer

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BACKGROUNDDelirium is common in patients with malignant disease and is associated with significant morbidity. Studies have not examined the epidemiology of delirium in patients undergoing hematopoietic stem cell transplantation (HSCT). The objectives of this study were to determine the prevalence, incidence, severity, and duration of delirium in the acute phase of HSCT and to determine the pretransplantation risk factors for the occurrence and severity of delirium during this period.METHODSNinety adult patients with malignancies who were admitted to the Fred Hutchinson Cancer Research Center for their first HSCT were assessed prospectively from 1 week pretransplantation to 30 days posttransplantation. Delirium occurrence using the Delirium Rating Scale (DRS) and severity using the Memorial Delirium Assessment Scale (MDAS) were assessed three times per week. Pretransplantation risk factors were assessed by patient self‐report, charts, and computerized records.RESULTSThe cumulative posttransplantation incidence of delirium events (DRS score > 12) was 66 (73%), and the incidence of delirium episodes (DRS score > 12 for 2 of 3 consecutive assessments) was 45 (50%). The mean ± standard deviation duration of delirium episodes was 4.8 ± 2.8 assessments (approximately 10 days). Pretransplantation risk factors for having a delirium episode were lower cognitive functioning (Trailmaking B test [a standardized test of visual conceptual and visuomotor tracking and cognitive flexibility]; P = 0.0008), higher blood urea nitrogen (P = 0.002), higher alkaline phosphatase (P = 0.008), lower physical functioning (SF‐12 [self report questionnaire that is a general measure of functioning]; P = 0.03), and higher magnesium (P = 0.03). Pretransplantation risk factors for higher delirium severity scores were higher creatinine (P < 0.0001), the presence of total body irradiation (P = 0.0001), higher magnesium (P = 0.0003), lower Mini‐Mental State Examination score (P = 0.002), malignancy diagnosis category (P = 0.002), female gender (P = 0.008), higher alkaline phosphatase (P = 0.02), older age (P = 0.03), and prior alcohol or drug abuse (P = 0.046).CONCLUSIONSHalf of patients who undergo HSCT experience a delirium episode during the 4 weeks posttransplantation. Pretransplantation risk factors can assist in identifying patients who are more likely to develop delirium posttransplantation. Cancer 2002;95:1971–81. © 2002 American Cancer Society.DOI 10.1002/cncr.10889

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A Prospective Study of Delirium and Prolonged Hospital Stay

Cited by 213 publications

References 22 publications

Pathophysiology of Delirium in the Intensive Care Unit

Pathophysiology of Delirium in the Intensive Care Unit

Delirium risk factors in elderly hospitalized patients

Delirium in patients undergoing hematopoietic stem cell transplantation

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