Risk factors for inducing violence in patients with delirium

Tachibana, Masakatsu; Inada, Toshiya; Ichida, Masaru; Ozaki, Norio

doi:10.1002/brb3.2276

Cited by 7 publications

(9 citation statements)

References 20 publications

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“…[ 27 , 30 – 34 , 39 – 41 , 43 , 48 , 50 , 52 , 55 , 58 , 59 , 61 , 67 , 68 , 72 , 73 , 76 – 82 , 84 – 86 , 91 – 93 , 95 , 96 ]…”

Section: Resultsunclassified

“…The most frequently reported patient-related characteristic associated with violence was the impairment by illness or drugs [ 17 , 28 , 47 , 49 , 53 , 63 , 70 ] with illness severity attributed as the cause of 4% to 80% of violent episodes in two studies [ 28 , 49 ]. Patients over the age of 65 years and male patients were reported to show violent behaviors more frequently, especially when being hospitalized for more than one week [ 26 , 27 , 49 , 53 ]. Another factor causing violence, especially from families and relatives, was miscommunication, distrust against HCWs, and difficult patient situations or billing issues [ 39 , 50 , 61 , 72 , 78 , 82 , 92 ].…”

Section: Resultsmentioning

confidence: 99%

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Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

Berger,

Grzonka,

Frei

et al. 2024

Crit Care

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Background To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units. Methods PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools. Results Seventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37–75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22–41%) for physical violence, 57% for verbal violence (95% CI 48–66%), and 12% for sexual violence (95% CI 4–23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low. Conclusions Workplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated. Systematic review registration: The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

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“…[ 27 , 30 – 34 , 39 – 41 , 43 , 48 , 50 , 52 , 55 , 58 , 59 , 61 , 67 , 68 , 72 , 73 , 76 – 82 , 84 – 86 , 91 – 93 , 95 , 96 ]…”

Section: Resultsunclassified

Section: Resultsmentioning

confidence: 99%

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

Berger,

Grzonka,

Frei

et al. 2024

Crit Care

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“…Overall, the conditions with the highest fractional utilization of restraint coding involve illnesses associated with neurologic impairment, including encephalitis, poisoning, stroke, traumatic brain injury, and neurocognitive disorders. While the NIS does not include the primary indication for restraint status, prior literature has implicated encephalopathy/delirium 26 , 27 and dementia 28 , 29 in agitation with high risk to caregivers, which may explain the utilization of physical restraints in these patients. As evidence suggests limitations in the use of coded data for identification of both dementia and delirium, interpretation of this association is limited 30 – 33 ; nevertheless, given the specific morbidity of these groups, further research is on optimal use of restraints in service of health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Coding for Physical Restraint Status Among Hospitalized Patients: a 2019 National Inpatient Sample Analysis

et al. 2023

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Background The reduction of physical restraint utilization in the hospital setting is a key goal of high-quality care, but little is known about the rate of restraint use in general hospitals in the USA. Objective This study reports the rate of physical restraint coding among acute care hospital discharges in the USA and explores associated demographic and diagnostic factors. Design The National Inpatient Sample, a de-identified all-payors database of acute care hospital discharges in the USA, was queried for patients aged 18 and older with a diagnosis code for physical restraint status in 2019. Participants Hospitalized patients aged 18 and older. Main Measures Demographics, discharge diagnoses, in-hospital mortality, length of stay, total hospital charges. Key Results In total, 220,470 (95% CI: 208,114 to 232,826) hospitalizations, or 0.7% of overall hospitalizations, included a discharge code for physical restraint status. There was a 700-fold difference in coding for restraint utilization based on diagnosis, with 7.4% of patients with encephalitis receiving restraint diagnosis codes compared to < 0.01% of patients with uncomplicated diabetes. In an adjusted model, male sex was associated with an odds ratio of 1.4 (95% CI: 1.4 to 1.5) for restraint utilization coding, and Black race was associated with an odds ratio of 1.3 (95% CI: 1.2 to 1.4) relative to white race. Conclusions In the general hospital setting, there is variability in physical restraint coding by sex, race, and clinical diagnosis. More research is needed into the appropriate utilization of restraints in the hospital setting and possible inequities in restraint utilization. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08179-3.

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“…After reading the full text of the retrieved papers, 13 were assessed as eligible. The other 43 reports were excluded for the following reasons: 22 did not provide any formal assessment of delirium , 10 did not include patients with acute stroke [42][43][44][45][46][47][48][49][50][51], 9 did not report any sleep evaluation [52][53][54][55][56][57][58][59][60], in one study sleep disorders were considered as delirium-related symptoms [61], and one was a study protocol registration [62].…”

Section: Study Selectionmentioning

confidence: 99%

Sleep and Stroke-Related Delirium: A Systematic Review

Brunetti

Rollo

Scala

et al. 2023

CTN

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Study objectives: Sleep and circadian rhythms disorders are frequent in the acute stroke. Sleep modifications are likely to contribute to the development of stroke-related delirium, a common neuropsychiatric complication of acute stroke. This systematic review aimed to clarify the association between sleep modifications and the occurrence of delirium in patients with acute stroke. Methods: The current systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was performed on PubMed and Scopus databases. Only studies that provided data concerning sleep, or pre-existing sleep disorders, in acute stroke and performed a formal evaluation of delirium were included. Results: The literature search enabled the identification of 15 studies, which exhibited high heterogeneity in terms of study design, settings, sleep assessments, delirium measures, and types of sleep intervention. In the study quality assessment, the majority of the studies were rated as weak or moderate. In most of the cases, sleep was subjectively assessed by the patients or rated by clinicians. None of the studies performed polysomnography for the evaluation of sleep. Only four of the studies assessed the impact of a sleep intervention on delirium, suggesting the potentially protective role of sleep promotion in reducing the prevalence and severity of stroke-related delirium. Conclusions: The evidence arising from the present systematic review supports that sleep disruption is a potential promoting factor for stroke-related delirium. We suggest that a formal sleep assessment and sleep promotion should be included in routine stroke care.

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Risk factors for inducing violence in patients with delirium

Cited by 7 publications

References 20 publications

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

Coding for Physical Restraint Status Among Hospitalized Patients: a 2019 National Inpatient Sample Analysis

Sleep and Stroke-Related Delirium: A Systematic Review

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