Kirsten M Fiest1, Andrea Soo2, Chel Hee Lee2, Daniel J Niven3, E Wesley Ely4, Christopher J Doig5, Henry T Stelfox6. 1. University of Calgary Cumming School of Medicine, 70401, Calgary, Alberta, Canada; kmfiest@ucalgary.ca. 2. Alberta Health Services, 3146, Critical Care Medicine, Edmonton, Alberta, Canada. 3. University of Calgary, 2129, Department of Critical Care Medicine, Calgary, Alberta, Canada. 4. Vanderbilt University School of Medicine, 12327, Nashville, Tennessee, United States. 5. University of Calgary Cumming School of Medicine, 70401, Critical Care Medicine, Calgary, Alberta, Canada. 6. University of Calgary, 2129, Calgary, Alberta, Canada.
Abstract
RATIONALE: Delirium is common in the intensive care unit (ICU) and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post-hospital discharge mortality and health resource utilization is less well known. OBJECTIVES: To estimate mortality and health resource utilization 2.5-years post-hospital discharge in critically ill patients admitted to ICU. METHODS: Population-based, propensity-score matched, retrospective cohort study of adult patients admitted to one of fourteen medical-surgical ICUs from January 1, 2014 to June 30, 2016. Delirium was measured by the 8-point Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality. The secondary outcome was a composite measure of subsequent emergency department visits, hospital readmission, or mortality. MEASUREMENTS AND MAIN RESULTS: There were 5,936 propensity score matched patients with and without incident delirium who survived to hospital discharge. Delirium was associated with increased mortality 0 to 30-days post-hospital discharge [Hazard Ratio (HR): 1.44 (95%CI: 1.08-1.92)]. There was no significant difference in mortality more than 30 days post-hospital discharge (delirium: 3.9%, no delirium: 2.6%). There was a persistent increased risk of emergency department visits, hospital readmissions, or mortality post-hospital discharge [HR: 1.12 (95%CI: 1.07-1.17)] throughout the study period. CONCLUSIONS: ICU delirium is associated with increased mortality 0 to 30 days post-hospital discharge. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
RATIONALE: Delirium is common in the intensive care unit (ICU) and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post-hospital discharge mortality and health resource utilization is less well known. OBJECTIVES: To estimate mortality and health resource utilization 2.5-years post-hospital discharge in critically illpatients admitted to ICU. METHODS: Population-based, propensity-score matched, retrospective cohort study of adult patients admitted to one of fourteen medical-surgical ICUs from January 1, 2014 to June 30, 2016. Delirium was measured by the 8-point Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality. The secondary outcome was a composite measure of subsequent emergency department visits, hospital readmission, or mortality. MEASUREMENTS AND MAIN RESULTS: There were 5,936 propensity score matched patients with and without incident delirium who survived to hospital discharge. Delirium was associated with increased mortality 0 to 30-days post-hospital discharge [Hazard Ratio (HR): 1.44 (95%CI: 1.08-1.92)]. There was no significant difference in mortality more than 30 days post-hospital discharge (delirium: 3.9%, no delirium: 2.6%). There was a persistent increased risk of emergency department visits, hospital readmissions, or mortality post-hospital discharge [HR: 1.12 (95%CI: 1.07-1.17)] throughout the study period. CONCLUSIONS: ICU delirium is associated with increased mortality 0 to 30 days post-hospital discharge. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).