Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study.
Yanbin Pan, Jianlong Yan, Zhixia Jiang and 3 others
PMID 31508442WHAT IT FOUND
In 452 ICU patients, 36.1% developed delirium.
Restraint, sedatives, and ICU stay of 7 days or more together were linked with a reported combined association value of 30.950. Nurses should monitor delirium and limit restraint.
Key findings
01Among 452 ICU patients, 163 developed delirium (36.1%); 44.2% were hyperactive, 43.5% hypoactive, and 12.3% mixed.
02The delirium group had higher APACHE II score (16.6 ± 6.2 vs 15.2 ± 7.0, P = 0.034), mechanical ventilation (90.8% vs 74.0%), sedative use (87.7% vs 64.7%), analgesic use (78.5% vs 62.6%), physical restraint (95.1% vs 73.0%), longer ICU stay (median 9 days vs 6 days), and more intubations (5.3 ± 1.5 vs 4.9 ± 1.7).
03Physical restraint, sedative use, and ICU stay of 7 days or more together were linked with a cumulative odds ratio of 30.950.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-center case-control study, so results may not apply to other ICUs or populations. Delirium was assessed by nurses without clinician participation and only daily, which may underestimate delirium. Exposure data came from medical and nursing records, and only selected risk factors were considered. The study did not follow patients after discharge for survival, re-hospitalization, or mortality. The cumulative value is an association from regression, not proof that changing any single factor will prevent delirium.
Declared interests
A Guizhou Province education humanities and social sciences project supported the work, and the authors declared no conflict of interest.
The easy way to misread this
Do not read the reported combined association value of 30.950 as proof that physical restraint, sedatives, and ICU stay of 7 days or more caused delirium. This was a single-center case-control study using daily nurse assessment and record-based exposure data, so confounding and under-detection remain possible.