Research

Risk factors for delirium in intensive care patients: a prospective cohort study

Bart Van Rompaey^1,2 , Monique M Elseviers¹ , Marieke J Schuurmans³ , Lillie M Shortridge-Baggett⁴ , Steven Truijen² and Leo Bossaert^5,6

¹  University of Antwerp, Faculty of Medicine, Division of Nursing Science and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium

²  Artesis University College of Antwerp, Department of Health Sciences, J. De Boeckstraat 10, 2170 Merksem, Belgium

³  University of Professional Education Utrecht, Department of Healthcare, Bolognalaan 101, postbus 85182, 3508 AD Utrecht, The Netherlands

⁴  Pace University, Lienhard School of Nursing, Lienhard Hall, Pleasantville, New York 10570, USA

⁵  University Hospital of Antwerp, Intensive Care Department, Belgium

⁶  University of Antwerp, Faculty of Medicine, Universiteitsplein 1, 2610 Wilrijk, Belgium

author email corresponding author email

Critical Care 2009, 13:R77doi:10.1186/cc7892

Published:	20 May 2009

Abstract

Introduction

Delirium is a common complication in the intensive care unit. The attention of researchers has shifted from the treatment to the prevention of the syndrome necessitating the study of associated risk factors.

Methods

In a multicenter study at one university hospital, two community hospitals and one private hospital, all consecutive newly admitted adult patients were screened and included when reaching a Glasgow Coma Scale greater than 10. Nurse researchers assessed the patients for delirium using the NEECHAM Confusion Scale. Risk factors covered four domains: patient characteristics, chronic pathology, acute illness and environmental factors. Odds ratios were calculated using univariate binary logistic regression.

Results

A total population of 523 patients was screened for delirium. The studied factors showed some variability according to the participating hospitals. The overall delirium incidence was 30%. Age was not a significant risk factor. Intensive smoking (OR 2.04), daily use of more than three units of alcohol (OR 3.23), and living alone at home (OR 1.94), however, contributed to the development of delirium. In the domain of chronic pathology a pre-existing cognitive impairment was an important risk factor (OR 2.41). In the domain of factors related to acute illness the use of drains, tubes and catheters, acute illness scores, the use of psychoactive medication, a preceding period of sedation, coma or mechanical ventilation showed significant risk with odds ratios ranging from 1.04 to 13.66. Environmental risk factors were isolation (OR 2.89), the absence of visit (OR 3.73), the absence of visible daylight (OR 2.39), a transfer from another ward (OR 1.98), and the use of physical restraints (OR 33.84).

Conclusions

This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness, and the environment. Particularly among those related to the acute illness and the environment, several factors are suitable for preventive action.