A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study

• DOI: 10.1186/s12913-018-3345-x
• Publication Date: 2018-07-13T09:39:54Z
• Authors: Maria Schubert; Roger Schürch; Soenke Boettger; David Garcia Nuñez; Urs Schwarz; Dominique Bettex; Josef Jenewein; Jasmina Bogdanovic; Marina Lynne Staehli; Rebecca Spirig; Alain Rudiger
• Keywords: Adult; Male; Critical Care; 10216 Institute of Anesthesiology; Hospital mortality; 610 Medicine & health; 616.8: Neurologie und Krankheiten des Nervensystems; Cost of diseases OR economic burden of diseases; Cohort Studies; Hospitals, University; Neurocognitive disorders; 03 medical and health sciences; 0302 clinical medicine; 360 Social problems & social services; Risk Factors; Prevalence; Humans; Neurocognitive disorder; Hospital Mortality; Aged; Health Policy; Patient Acuity; 362.1041: Gesundheitsökonomie; Delirium; Length of Stay; Middle Aged; 2719 Health Policy; 10040 Clinic for Neurology; 3. Good health; Intensive Care Units; 10057 Klinik für Konsiliarpsychiatrie und Psychosomatik; 362.11: Krankenhäuser und verwandte Einrichtungen; Length of stay; Female; 10023 Institute of Intensive Care Medicine; Public aspects of medicine; RA1-1270; Switzerland; Research Article

Background: Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case. Methods: This cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included. Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4. Results: Of 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium. Conclusions: The results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups.