Effects of routine monitoring of delirium in a surgical/trauma intensive care unit.

Published

Journal Article

BACKGROUND: Delirium is prevalent in surgical and trauma intensive care units (ICUs) and carries substantial morbidity. This study tested the hypothesis that daily administration of a diagnostic instrument for delirium in a surgical/trauma ICU decreases the time of institution of pharmacologic therapy and improves related outcomes. METHODS: Controlled trial of two concurrent groups. The Confusion-Assessment Method for ICU was administered daily to all eligible patients admitted to our surgical/trauma ICU for 48 hours or longer. The result was communicated to one of the two preexisting ICU services (intervention service) and not the other (control service). Primary outcome was the time between diagnosis of delirium and pharmacologic treatment. Secondary outcomes included duration of delirium, mechanical ventilation, and ICU stay. RESULTS: Delirium occurred in 98 (35%) of 283 consecutive patients. Time between diagnosis and therapy did not differ between intervention (35 [35] hours) and control (40 [41] hours) groups. There was a difference in the number of delirium days treated in the intervention (73%) versus control (64%) groups (p = 0.035). The intervention group had significantly lower odds to neglect treating delirium when delirium was present (odds ratio, 0.67; 95% confidence interval, 0.45-1.00; p = 0.05). In the subgroup of trauma patients, the odds ratio of negligence was 0.37 (95% confidence interval, 0.14-0.99; p = 0.048), indicating lower probability for trauma patients to be untreated. There was no difference in the average duration of delirium, mechanical ventilation, and ICU stay. CONCLUSION: In our surgical/trauma ICU, daily screening for delirium did not affect the timing of pharmacologic therapy. Although the intervention resulted in a higher number of delirious ICU patients being treated, particularly trauma patients, there was no effect on related outcomes. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Full Text

Duke Authors

Cited Authors

  • Bigatello, LM; Amirfarzan, H; Haghighi, AK; Newhouse, B; Del Rio, JM; Allen, K; Chang, A; Schmidt, U; Razavi, M

Published Date

  • March 2013

Published In

Volume / Issue

  • 74 / 3

Start / End Page

  • 876 - 883

PubMed ID

  • 23425751

Pubmed Central ID

  • 23425751

Electronic International Standard Serial Number (EISSN)

  • 2163-0763

Digital Object Identifier (DOI)

  • 10.1097/TA.0b013e31827e1b69

Language

  • eng

Conference Location

  • United States