Patricia S Andrews1, Sophia Wang2, Anthony J Perkins3, Sujuan Gao4, Sikandar Khan5, Heidi Lindroth6, Malaz Boustani7, Babar Khan8. 1. About the Authors: Patricia S. Andrews is an assistant professor, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee. 2. Sophia Wang is an assistant professor, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana. 3. Anthony J. Perkins is a staff biostatistician, Department of Biostatistics, Indiana University School of Medicine. 4. Sujuan Gao is a professor, Department of Biostatistics, Indiana University School of Medicine. 5. Sikandar Khan is an assistant professor, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine; and a research scientist, Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana. 6. Heidi Lindroth is a postdoctoral fellow, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine; and an affiliate at the Indiana University Center for Aging Research, Regenstrief Institute. 7. Malaz Boustani is a professor, Department of Medicine, Indiana University School of Medicine; the founding director, Center for Health Innovation and Implementation Science at Indiana Clinical Translational Science Institute; director of senior care innovation, Eskenazi Hospital; and a research scientist, Indiana University Center for Aging Research, Regen strief Institute. 8. Babar Khan is an associate professor, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine; and a research scientist, Indiana University Center for Aging Research, Regenstrief Institute.
Abstract
BACKGROUND: Critical care patients with delirium are at an increased risk of functional decline and mortality long term. OBJECTIVE: To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. METHODS: A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. RESULTS: Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. CONCLUSION: Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.
RCT Entities:
BACKGROUND: Critical care patients with delirium are at an increased risk of functional decline and mortality long term. OBJECTIVE: To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. METHODS: A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. RESULTS: Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. CONCLUSION: Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.
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