Subsyndromal Delirium and Institutionalization Among Patients With Critical Illness.
Nathan E Brummel, Leanne M Boehm, Timothy D Girard and 11 others
PMID 29092867WHAT IT FOUND
For ICU patients, more days of subsyndromal delirium predicted discharge away from home, especially in those with little or no full delirium.
Key findings
01Subsyndromal delirium occurred in 702 of 821 patients (86%), and median duration was 3 days.
02After adjustment, longer duration of subsyndromal delirium was independently associated with higher odds of institutionalization (p=0.007).
03The association was strongest in patients with the fewest days of delirium; among typical never-delirious patients, 5 days of subsyndromal delirium versus 1.5 days was associated with 4.2 times higher odds of institutionalization.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an observational cohort, so it shows association, not that subsyndromal delirium caused institutionalization. Subsyndromal delirium has no standard definition, and the CAM-ICU was used to identify it rather than as a validated severity score. Some patients were sedated, and the analysis counted delirium features regardless of whether sedation may have caused them. Missing mental status features were imputed in 28% of assessments. The study did not collect whether patients already lived in an institution before critical illness, which could affect discharge outcome. The association with subsyndromal delirium duration changed depending on how many days of delirium a patient had, so the result is not the same for all patients.
Declared interests
The remaining authors report no financial conflicts of interest.
The easy way to misread this
Do not conclude that detection or treatment of subsyndromal delirium will reduce institutionalization. The study shows an adjusted association in a cohort, and the strength of that association depended on delirium duration.