Classification of daily mental status in critically ill patients for research purposes

Zaal, Irene J.; Tekatli, H.; Kooi, Arendina W. van der; Klijn, Francina A.; Koek, Huiberdina L.; Dijk, Diederik van; Slooter, Arjen J. C.

doi:10.1016/j.jcrc.2014.10.031

Cited by 22 publications

(23 citation statements)

References 33 publications

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“…The study population consisted of mixed medical‐surgical ICU patients, which contributes to the generalizability of our results. The validated delirium assessment conducted by research nurses reduced the risk of misclassifying subjects . The response rate was relatively high thanks to careful follow‐up of subjects using a postal reminder and follow‐up phone calls.…”

Section: Discussionmentioning

confidence: 99%

“…The validated delirium assessment conducted by research nurses reduced the risk of misclassifying subjects. 13 The response rate was relatively high thanks to careful follow-up of subjects using a postal reminder and follow-up phone calls. Furthermore, similar results were found in secondary analyses with multiple imputation, indicating that the results were robust.…”

Section: Discussionmentioning

confidence: 99%

“…A detailed description of the daily assessment of mental status was recently published . In brief, an algorithm was used to evaluate daily mental status of each patient during the preceding 24 hours (awake without delirium, delirium, or coma).…”

Section: Methodsmentioning

confidence: 99%

“…A detailed description of the daily assessment of mental status was recently published. 13 In brief, an algorithm was used to evaluate daily mental status of each patient during the preceding 24 hours (awake without delirium, delirium, or coma). For this assessment, the Richmond Agitation Sedation Scale (RASS) 14 and Confusion Assessment Method for the ICU (CAM-ICU) 15 scores from the bedside nurses were used, next to initiation of treatment with neuroleptic drugs in the previous 24 hours, chart review, and an additional CAM-ICU by trained research nurses.…”

Section: Data Collectionmentioning

confidence: 99%

“…For this assessment, the Richmond Agitation Sedation Scale (RASS) 14 and Confusion Assessment Method for the ICU (CAM-ICU) 15 scores from the bedside nurses were used, next to initiation of treatment with neuroleptic drugs in the previous 24 hours, chart review, and an additional CAM-ICU by trained research nurses. 13 All subjects who were alive 1 year after ICU discharge received a survey by mail containing multiple questionnaires, including the validated Dutch translation of the Cognitive Failures Questionnaire (CFQ), 16,17 which has been used as a long term outcome in postoperative care and critical illness populations before. 18,19 The CFQ consists of 25 questions, scored on a 5-point Likert scale, and measures self-reported frequencies of failures in attention, memory, and action.…”

Section: Data Collectionmentioning

confidence: 99%

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Long‐Term Self‐Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation

Wolters

Peelen

Veldhuijzen

et al. 2017

J American Geriatrics Society

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OBJECTIVES:To describe the association between intensive care unit (ICU) delirium and self-reported cognitive problems in 1-year ICU survivors, and investigate whether this association was altered by exposure to systemic inflammation during ICU stay. DESIGN: Prospective cohort study. SETTING: Dutch medical-surgical ICU. PARTICIPANTS: One-year ICU survivors, admitted to the ICU ≥48 hours. MEASUREMENTS: Self-reported cognitive problems were measured with the Cognitive Failures Questionnaire (CFQ). Cumulative exposure to systemic inflammation was based on all daily C-reactive protein (CRP) measurements during ICU stay, expressed as the area under the curve (AUC). Multivariable linear regression was conducted to evaluate the association between delirium and the CFQ. The effect of inflammation on the association between delirium and CFQ was assessed, comparing the effect estimate (B) of delirium and CFQ between models with and without inclusion of the AUC of CRP. RESULTS: Among 567 1-year ICU survivors, the CFQ was completed by 363 subjects. Subjects with multiple days of delirium during ICU stay reported more selfreported cognitive problems (Badj = 5.10, 95% CI 1.01-9.20), whereas a single day delirium was not associated with higher CFQ scores (Badj = À0.72, 95% CI À5.75 to 4.31). Including the AUC of CRP did not change the association between delirium and the CFQ (ratio for a single and multiple days were respectively: 1.00, 95%CI 0.59-1.44 and 0.86, 95% CI 0.47-1.16). CONCLUSION: Multiple days of delirium was associated with long-term self-reported cognitive problems. The cumulative exposure to systemic inflammation did not alter this association, suggesting that delirium in the context of little inflammation is also detrimental. J Am Geriatr Soc 65:786-791, 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

See 3 more Smart Citations

Long‐Term Self‐Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation

Wolters

Peelen

Veldhuijzen

et al. 2017

J American Geriatrics Society

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Association of Incident Delirium With Short-term Mortality in Adults With Critical Illness Receiving Mechanical Ventilation

Yeh

Wei

et al. 2022

JAMA Netw Open

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ImportanceIntensive care unit (ICU)–acquired delirium and/or coma have consequences for patient outcomes. However, contradictory findings exist, especially when considering short-term (ie, in-hospital) mortality and length of stay (LOS).ObjectiveTo assess whether incident delirium, days of delirium, days of coma, and delirium- and coma-free days (DCFDs) are associated with 14-day mortality, in-hospital mortality, and hospital LOS among patients with critical illness receiving mechanical ventilation.Design, Setting, and ParticipantsThis single-center prospective cohort study was conducted in 6 ICUs of a university-affiliated tertiary hospital in Taiwan. A total of 267 delirium-free patients (aged ≥20 years) with critical illness receiving mechanical ventilation were consecutively enrolled from August 14, 2018, to October 1, 2020.ExposuresParticipants were assessed daily for the development of delirium and coma status over 14 days (or until death or ICU discharge) using the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale, respectively.Main Outcomes and MeasuresMortality rates (14-day and in-hospital) and hospital LOS using electronic health records.ResultsOf 267 participants (median [IQR] age, 65.9 [57.4-75.1] years; 171 men [64.0%]; all of Taiwanese ethnicity), 149 patients (55.8%) developed delirium for a median (IQR) of 3.0 (1.0-5.0) days at some point during their first 14 days of ICU stay, and 105 patients (39.3%) had coma episodes also lasting for a median (IQR) of 3.0 (1.0-5.0) days. The 14-day and in-hospital mortality rates were 18.0% (48 patients) and 42.1% (112 of 266 patients [1 patient withdrew from the study]), respectively. The incidence and days of delirium were not associated with either 14-day mortality (incident delirium: adjusted hazard ratio [aHR], 1.37; 95% CI, 0.69-2.72; delirium by day: aHR, 1.00; 95% CI, 0.91-1.10) or in-hospital mortality (incident delirium: aHR, 1.00; 95% CI, 0.64-1.55; delirium by day: aHR, 1.02; 95% CI, 0.97-1.07), whereas days spent in coma were associated with an increased hazard of dying during a given 14-day period (aHR, 1.16; 95% CI, 1.10-1.22) and during hospitalization (aHR, 1.10; 95% CI, 1.06-1.14). The number of DCFDs was a protective factor; for each additional DCFD, the risk of dying during the 14-day period was reduced by 11% (aHR, 0.89; 95% CI, 0.84-0.94), and the risk of dying during hospitalization was reduced by 7% (aHR, 0.93; 95% CI, 0.90-0.97). Incident delirium was associated with longer hospital stays (adjusted β = 10.80; 95% CI, 0.53-21.08) when compared with no incident delirium.Conclusions and RelevanceIn this study, despite prolonged LOS, ICU delirium was not associated with short-term mortality. However, DCFDs were associated with a lower risk of dying, suggesting that future research and intervention implementation should refocus on maximizing DCFDs to potentially improve the survival of patients receiving mechanical ventilation.

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Benzodiazepine-associated delirium in critically ill adults

et al. 2015

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Classification of daily mental status in critically ill patients for research purposes

Cited by 22 publications

References 33 publications

Long‐Term Self‐Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation

Long‐Term Self‐Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation

Association of Incident Delirium With Short-term Mortality in Adults With Critical Illness Receiving Mechanical Ventilation

Benzodiazepine-associated delirium in critically ill adults

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