Risk factors, time to onset and recurrence of delirium in a mixed medical-surgical ICU population: a secondary analysis using Cox and CHAID decision tree modeling

Rahimi–Bashar, Farshid; Miller, Andrew C.; Salesi, Mahmood; Bagheri, Motahareh; Vahedian‐Azimi, Amir; Ashtari, Sara; Moghadam, Keivan Gohari; Sahebkar, Amirhossein

doi:10.17179/excli2021-4381

Cited by 6 publications

(7 citation statements)

References 83 publications

(108 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Combining the results regarding delirium and subtype assessment tools in knowledge and practice dimensions, we speculate that there is misunderstanding and unfamiliarity in subtype assessment tools among nurses. Additionally, nurses misunderstand (75.1%) delirium prevention and restraint, which is associated with that a retrospective secondary analysis of 4,200 patients in Iran showing that increased delirium risk was associated with exposure to physical restraint application ( 66 ). However, most nurses know about the adverse outcomes and high-risk factors for delirium, which is the same as Xie's survey findings among orthopedic professional nurses and Xu's among ICU nurses ( 59 , 61 ).…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitude, and practice toward delirium and subtype assessment among Chinese clinical nurses and determinant factors: A multicentre cross-section study

et al. 2023

View full text Add to dashboard Cite

BackgroundDelirium, a confused transient state of consciousness, can be divided into hyperactive, hypoactive, mixed, and no motor subtypes, according to different clinical manifestations. Several studies have investigated delirium subtypes in the knowledge dimension, but few studies have investigated delirium subtype in the attitude and practice dimensions. The barriers, knowledge sources, and practice details regarding subtype assessment are unclear.ObjectivesThis study had three objectives. First, we planned to investigate the KAP status regarding delirium and subtypes for nurses. Second, we wanted to identify factors affecting clinical nurses' KAP scores. Third, this study expected to explore more details regarding delirium and subtypes assessment, including assessment barriers, assessment instruments, and knowledge sources.MethodsThis multicentre cross-section study was conducted in 10 tertiary hospitals in three provinces, China, from January to April 2022. We investigated 477 nurses from six departments with a high prevalence. The self-developed KAP questionnaire regarding delirium and subtypes assessment had four parts: knowledge, attitude, practice, and source. Its reliability and validity were verified effectively by 2-round Delphi expert consultation.ResultsA total of 477 nurses from the general intensive care unit (ICU), specialty ICU, orthopedics, thoracic surgery, operating room, and geriatrics were 28.3, 22.4, 22.2, 10.5, and 5.2%, respectively. The total KAP score regarding delirium and subtypes assessment was 60.01 ± 6.98, and the scoring rate was 73.18%. The scoring rate for knowledge, attitude, and practice was 58.55, 83.94, and 51.70%, respectively. More than half (54.1%) were unaware of the delirium subtypes assessment instruments. A total of 451 (94.6%) participants recognized the importance of nursing work for delirium prevention. A total of 250 (52.4%) nurses occasionally or sometimes assessed delirium subtypes, and 143 (30.0%) never assessed for delirium subtypes. We found that age, department, technical title, familiarity with delirium, familiarity with delirium subtypes, delirium training, and subtype training affected the total KAP scores. ICU nurses achieved the highest scores.ConclusionChinese nurses' KAP status regarding delirium and subtypes assessment were barely acceptable, and the attitude score was positive, but knowledge and practice needed improvement. Meanwhile, the department was one of the significant KAP factors, and ICU nurses did better in delirium and subtype assessment in knowledge and practice dimension than other departments. Systematic and scientific training processes including subtype content and assessment tools are required. Experience still drives nurses' assessments of delirium and subtype. Adding the delirium assessment into routine tasks should be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Knowledge, attitude, and practice toward delirium and subtype assessment among Chinese clinical nurses and determinant factors: A multicentre cross-section study

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Masuyama et al reported the median time and the interquartile range as 3.81 days and 1.81 to 5.79 days in overall, 5.06 days and 3.08 to 8.81 days in the exposure group, and 3.59 days and 1.59 to 4.90 days in the control group in the ICU [ 8 ]. Rahimibashar et al reported the mean time to the recognition of delirium as 7.55 ± 1.88 days in their study conducted in two teaching-hospital ICUs [ 22 ]. Based on Kaplan-Meier curves reported in previous studies, the median time to the onset of delirium from the time of ICU admission is about 3 to 5 days regardless of the study location [ 5 – 9 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Reducing the effect of immortal time bias affects the analysis of prevention of delirium by suvorexant in critically ill patients: A retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

Background Studies assessing the effect of suvorexant on delirium prevention included patients treated before development of delirium, which can introduce immortal time bias. The objective of the present study was to evaluate the effect of suvorexant on delirium, comparing patients treated before the onset of delirium with patients treated within 72h of admission using the same dataset. Methods Data from adult patients admitted to the ICU from August 2018 to July 2021 were retrospectively analyzed. In “any time before” analysis, the incidence of delirium was compared for patients who received suvorexant at any time during their ICU stay (suvorexant) (unless delirium developed before treatment) with patients who either did not receive suvorexant or received suvorexant after development of delirium (control). This design was used in previously published studies. In “within 72h” analysis, the incidence of delirium was compared for patients who received suvorexant within 72 hours of admission (suvorexant) and patients who did not receive suvorexant or received it more than 72 hours after admission (control). Patients who developed delirium during the initial 72 hours were excluded from “within 72h” analysis (N = 799). Results “Within 72h” analysis included 1,255 patients, and “any time before” analysis included 2,054 patients (of 6599 admissions). The unadjusted hazard ratio of “any time before” analysis was 0.16 and the 95% confidence interval was 0.13–0.21 (p<0.01). The adjusted hazard ratio was 0.21, and the 95% confidence interval was 0.16–0.27 (p<0.01). “Within 72h” analysis had an unadjusted hazard ratio of 0.54 and the 95% confidence interval was 0.36–0.82 (p<0.01). However, this association lost statistical significance after adjustment for potential confounders (adjusted hazard ratio 1.02, 95% confidence interval 0.65–1.59, p = 0.93). Conclusion Reducing the effect of immortal time bias led to a significantly reduced effect of suvorexant for the prevention of delirium.

show abstract

“… 14 A CHAID allows one to resolve whole variables and partition consecutive data effectively, and the forward stopping or pruning rules are used to construct decision trees. 15 In this study, we used a CHAID to create a decision tree predictive model, so as to predict the level of functional exercise compliance of patients with breast cancer after surgery.…”

Section: Introductionmentioning

confidence: 99%

Predictive Model of Functional Exercise Compliance of Patients with Breast Cancer Based on Decision Tree

Luo¹,

Luo²,

Wang³

et al. 2023

IJWH

View full text Add to dashboard Cite

Objective Regular functional exercise can help recover the functions of upper limb for patients with breast cancer. By finding the influencing factors of functional exercise compliance and constructing a predictive model, patients with a poor functional exercise compliance can be better identified. This study aims to find out the factors influencing the functional exercise compliance of patients with breast cancer and build a predictive model based on decision tree. Methods Convenience sampling was used at two tertiary hospitals in Shantou from August 2020 to March 2021. Data of patients with breast cancer patient was obtained from questionnaires and based on demographics, Constant-Murley Score, Functional Exercise Compliance Scale for Postoperative Breast Cancer Patients, Champion Health Belief Model Scale, Social Support Rating Scale, Disease Perception Questionnaire and Family Care Index Questionnaire. Possible influencing factors of functional exercise compliance were analyzed using correlation analysis as well as univariate and binary logistic regression analysis through SPSS v25, and a CHAID decision tree was used to construct a predictive model on training, validation and test sets via SPSS Modeler v18 at a ratio of 6:2:2. Prediction accuracy, sensitivity, specificity and AUC were used to analyze the efficacy of the predictive model. Results A total of 227 valid samples were collected, of which 145 were assessed with a poor compliance (63.9%). According to a logistic regression analysis, perceived benefits, time after surgery and self-efficacy were influencing factors. The prediction accuracy, sensitivity, specificity and AUC of the predictive model, based on a CHAID decision tree analysis, were 70.73%, 57.1%, 77.8% and 0.81 respectively. Conclusion The predictive model, based on a CHAID decision tree analysis, had a moderate predictive efficacy, which could be used as a clinical auxiliary tool for clinical nurses to predict patients’ functional exercise compliance.

show abstract

Risk factors, time to onset and recurrence of delirium in a mixed medical-surgical ICU population: a secondary analysis using Cox and CHAID decision tree modeling

Cited by 6 publications

References 83 publications

Knowledge, attitude, and practice toward delirium and subtype assessment among Chinese clinical nurses and determinant factors: A multicentre cross-section study

Knowledge, attitude, and practice toward delirium and subtype assessment among Chinese clinical nurses and determinant factors: A multicentre cross-section study

Reducing the effect of immortal time bias affects the analysis of prevention of delirium by suvorexant in critically ill patients: A retrospective cohort study

Predictive Model of Functional Exercise Compliance of Patients with Breast Cancer Based on Decision Tree

Contact Info

Product

Resources

About