Research
Delirium epidemiology in critical care (DECCA): an international study
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* Corresponding author: Jorge I Salluh jorgesalluh@yahoo.com.br
1 Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, 10° Andar; Praça Cruz Vermelha, 23; Rio de Janeiro-RJ; CEP: 20230-130, Brazil
2 Intensive Care Unit, Hospital da Bahia, Av. Prof. Magalhaes Neto, 1541, Pituba. Cep:41830-030, Salvador, Bahia, Brazil
3 Intensive Care Unit, Hospital Juan A. Fernandez, Cervino 3356, Buenos Aires (ZIP-1425), Argentina
4 Postgraduate Program Critical Care, Morones Prieto 3000 Doctores, 64710 Monterrey, Nuevo León, Mexico
5 Intensive Care Unit Hospital del Salvador y Clínica INDISA, Avenida Santa María 1810, Providencia, Zip 7500000, Santiago, Chile
6 Intensive Care Unit, Unidad de Terapia Intensiva Hospital Obrero N 1 Av Brasil s/n CP 8908, La Paz, Bolivia
7 Intensive Care Unit, Hospital Luis Vernaza, Ext. 2005 Julián Coronel y Loja, 2560300, Guayaquil, Ecuador
8 Intensive Care Unit, Hospital Naval, Avenida Santos Chocano s/n, CP 210001, Lima, Peru
9 Intensive Care Unit, Sanatorio Americano, 2466 Isabelino Bosch, CP 11600, Montevideo, Uruguay
10 Intensive Care Unit, Orlando Regional Medical Center, 86 W. Underwood, MP 80, Orlando, FL 32806, USA
11 Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo Km 12,500, Getafe, 28905, Madrid, Spain
12 Intensive Care Unit and Postgraduate Program, Universidad de Cartagena, Nuevo Hospital Bocagrande, Calle 5 kra 6, Cartagena, 57, Colombia
13 Intensive Care Unit, Pavilhão Pereira Filho, Santa Casa de Misericórdia de Porto Alegre, Rua Annes Dias 285 CEP-90020, Porto Alegre, Brazil
Critical Care 2010, 14:R210 doi:10.1186/cc9333
Please see related commentary by Stevens et al, http://ccforum.com/content/15/1/118
Published: 23 November 2010Abstract
Introduction
Delirium is a frequent source of morbidity in intensive care units (ICUs). Most data on its epidemiology is from single-center studies. Our aim was to conduct a multicenter study to evaluate the epidemiology of delirium in the ICU.
Methods
A 1-day point-prevalence study was undertaken in 104 ICUs from 11 countries in South and North America and Spain.
Results
In total, 975 patients were screened, and 497 fulfilled inclusion criteria and were enrolled (median age, 62 years; 52.5% men; 16.7% and 19.9% for ICU and hospital mortality); 64% were admitted to the ICU because of medical causes, and sepsis was the main diagnosis (n = 76; 15.3%). In total, 265 patients were sedated with the Richmond agitation and sedation scale (RASS) deeper than -3, and only 232 (46.6%) patients could be evaluated with the confusion-assessment method for the ICU. The prevalence of delirium was 32.3%. Compared with patients without delirium, those with the diagnosis of delirium had a greater severity of illness at admission, demonstrated by higher sequential organ-failure assessment (SOFA (P = 0.004)) and simplified acute physiology score 3 (SAPS3) scores (P < 0.0001). Delirium was associated with increased ICU (20% versus 5.7%; P = 0.002) and hospital mortality (24 versus 8.3%; P = 0.0017), and longer ICU (P < 0.0001) and hospital length of stay (LOS) (22 (11 to 40) versus 7 (4 to 18) days; P < 0.0001). Previous use of midazolam (P = 0.009) was more frequent in patients with delirium. On multivariate analysis, delirium was independently associated with increased ICU mortality (OR = 3.14 (1.26 to 7.86); CI, 95%) and hospital mortality (OR = 2.5 (1.1 to 5.7); CI, 95%).
Conclusions
In this 1-day international study, delirium was frequent and associated with increased mortality and ICU LOS. The main modifiable risk factors associated with the diagnosis of delirium were the use of invasive devices and sedatives (midazolam).