Risk factors, time to onset and recurrence of delirium in a mixed medical-surgical ICU population

A secondary analysis using Cox and CHAID decision tree modeling

Authors

  • Farshid Rahimibashar Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran https://orcid.org/0000-0001-8276-1425
  • Andrew C. Miller Department of Emergency Medicine, Alton Memorial Hospital, Alton, IL, USA https://orcid.org/0000-0001-8474-5090
  • Mahmood Salesi Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. E-mail: smahmood1360@yahoo.com https://orcid.org/0000-0003-3042-2143
  • Motahareh Bagheri Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran https://orcid.org/0000-0002-2133-7601
  • Amir Vahedian-Azimi Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0002-1678-7608
  • Sara Ashtari Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0003-1108-664X
  • Keivan Gohari Moghadam Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0002-1737-7782
  • Amirhossein Sahebkar Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran. Tel: +985138002299; Fax: +985138002287. E-mail: sahebkara@mums.ac.ir; amir_saheb2000@yahoo.com https://orcid.org/0000-0002-8656-1444

DOI:

https://doi.org/10.17179/excli2021-4381

Keywords:

delirium, Intensive Care Units, critical care, risk factors, Iran

Abstract

A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors. Increased delirium risk was associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95 % CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95 % CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95 % CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95 % CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95 % CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95 % CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95 % CI: 0.456-0.567, P<0.001). CHAID modeling indicated that AL exposure and age <65 years were associated with a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex was associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age >65 years (HR 2.198; 95 % CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95 % CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables. Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with the presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements.

Author Biographies

Farshid Rahimibashar, Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

wrong ORCID corrected to

https://orcid.org/0000-0001-8276-1425 (lindemann) Autor hat im Text diese genannt: https://orcid.org/0000-0001-8818-7209 (diese ist aber ungefüllt)!!!

Keivan Gohari Moghadam, Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

https://orcid.org/0000-0002-1737-7782

Additional Files

Published

2022-01-04

How to Cite

Rahimibashar, F., Miller, A. C., Salesi, M., Bagheri, M., Vahedian-Azimi, A., Ashtari, S., Gohari Moghadam, K., & Sahebkar, A. (2022). Risk factors, time to onset and recurrence of delirium in a mixed medical-surgical ICU population: A secondary analysis using Cox and CHAID decision tree modeling. EXCLI Journal, 21, 30–46. https://doi.org/10.17179/excli2021-4381

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