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Intern Med J. 2019 Mar 19. doi: 10.1111/imj.14287. [Epub ahead of print]

Differential Clinical Characteristics, Management, and Outcome of Delirium among Ward Compared with ICU Patients.

Author information

1
Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia.
2
School of Computing and Information Systems, The University of Melbourne, Parkville, Melbourne, Victoria, Australia.
3
Business Intelligence Unit, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia.
4
Pharmacy Department, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia.
5
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
6
School of Medicine, The University of Melbourne, Parkville, Melbourne, Victoria, Australia.
7
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
8
Data Analytics Research & Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Australia.

Abstract

BACKGROUND:

Delirium is common in hospitalized patients but its epidemiology remains poorly characterized.

AIMS:

To test the hypothesis that patient demographics, clinical phenotype, management, and outcomes of patient with delirium in hospital ward patients differ from ICU patients.

METHODS:

Retrospective cohort of patients admitted to an Australian university-affiliated hospital between March 2013 and April 2017 and coded for delirium at discharge using the ICD-10 criteria.

RESULTS:

Among 61,032 hospitalized patients, 2,864 (4.7%) were coded for delirium. From these, we studied a random sample of 100 ward patients and 100 ICU patients. Ward patients were older (median age: 84 vs. 65 years; P<0.0001), more likely to have dementia (38% vs. 2% for ICU patients; P<0.0001) and less likely to have had surgery (24 vs. 62%; P<0.0001). Of ward patients, 74% had hypoactive delirium, while 64% of ICU patients had agitated delirium (P<0.0001). Persistent delirium at hospital discharge was more common among ward patients (66% vs 17%, p<0.0001). On multivariable analysis, age and dementia predicted persistent delirium, while surgery predicted recovery.

CONCLUSIONS:

Delirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia, and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection, and goals of care should be adapted to the environment in which it occurs. This article is protected by copyright. All rights reserved.

KEYWORDS:

Agitation; Antipsychotics; Delirium; ICU; Ward

PMID:
30887670
DOI:
10.1111/imj.14287

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