The impact of delirium in the intensive care unit on hospital length of stay

Ely, E. Wesley; Gautam, Shiva; Margolin, Richard; Francis, Joseph; May, Lisa; Speroff, Theodore; Truman, Brenda; Dittus, Robert S.; Bernard, Gordon R.; Inouye, Sharon K.

doi:10.1007/s00134-001-1132-2

Cited by 919 publications

(613 citation statements)

References 62 publications

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“…The median time till first positive CAM-ICU occurred was 3 [1][2][3][4][5][6] days. Of note, apart from the considerable variation in delirium incidence there were important differences between countries concerning the incidence of delirium predictors (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Delirium, the acute onset of confusion and consciousness disturbances with a fluctuating course [1], occurs frequently in critically ill patients [2][3][4]. Delirium is associated with a prolonged stay in the intensive care unit (ICU) and hospital, increased morbidity and mortality rate, higher costs [2,3,5] and adverse long-term outcome [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Delirium is associated with a prolonged stay in the intensive care unit (ICU) and hospital, increased morbidity and mortality rate, higher costs [2,3,5] and adverse long-term outcome [6,7]. There are several delirium assessment tools for ICU patients such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).…”

Section: Introductionmentioning

confidence: 99%

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Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The 10 predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 hours after ICU admission. The confusion assessment method for the Intensive Care Unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data. Permanent repository linkResults: 2,852 adult ICU patients were screened of which 1,824 (64%) were eligible for the study. Main reasons for exclusion were length of stay <1day (19.1%) and sustained coma (4.1%). CAM-ICU compliance was mean (SD) 82±16% and inter-rater reliability 0.87±0.17. The median delirium incidence was 22.5% (IQR 12.8%-36.6%). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the 8 participating centers remained good: 0.77 (95%CI:0.74-0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved recalibration of the PRE-DELIRIC model. Conclusions:In this multinational study we recalibrated the PRE-DELIRIC-model. Despite differences in the incidence of predictors between the centers in the different countries the performance of the PRE-DELIRICmodel remained good. Following validation of the PRE-DELIRIC model it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.4

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

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“…Delirium in the ICU is associated with complications and adverse outcomes including prolonged hospital stay [4,5] and increased morbidity and mortality [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Intensive care unit environment may affect the course of delirium

et al. 2012

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Purpose: Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission. Methods: In this prospective before-after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis. Results: We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1-0.7) in the singleroom ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53). Conclusions: This study is the first to show that ICU environment may influence the course of delirium in ICU patients.

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“…Delirium involves acute and intermittent changes in mental status with disordered attention and cognition 1. Delirium has been shown to have negative clinical outcomes for in adult intensive care,2 such as increased length of hospital stay,3 mortality, and health‐care costs 4. However, the implications of pediatric delirium in the Japanese context are not well clarified because of the lack of an adequate screening tool.…”

Section: Introductionmentioning

confidence: 99%

Development of the Japanese version of the Cornell Assessment of Pediatric Delirium

Hoshino

Matsuishi

Shimojo

et al. 2017

Acute Medicine & Surgery

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AimDelirium is a form of acute cerebral dysfunction and is associated with increased length of hospital stay, mortality, and health‐care costs for adult patients in intensive care. However, in Japan, there are currently no reliable criteria or tools for diagnosing delirium in critically ill pediatric patients. The purpose of this study was to translate the Cornell Assessment of Pediatric Delirium (CAPD)—a screening tool for pediatric delirium—from English to Japanese for use in the diagnosis of delirium for pediatric patients in pediatric intensive care units.MethodsThe back‐translation method was used to ensure equivalence in the Japanese version of the CAPD and its accompanying developmental anchor points. The translation process was repeated by a multidisciplinary committee of medical researchers and clinicians.ResultsThe final back‐translated version of the CAPD was submitted to the original author, who gave her approval.ConclusionThe Japanese CAPD was developed and its effectiveness tested using a standardized procedure. Further study is required to test the validity and reliability of the Japanese version of the CAPD.

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The impact of delirium in the intensive care unit on hospital length of stay

Abstract: In this patient cohort, the majority of patients developed delirium in the ICU, and delirium was the strongest independent determinant of length of stay in the hospital. Further study and monitoring of delirium in the ICU and the risk factors for its development are warranted.

Cited by 919 publications

References 62 publications

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Intensive care unit environment may affect the course of delirium

Development of the Japanese version of the Cornell Assessment of Pediatric Delirium

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