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Chen S, Tang L, Chen J, Cai L, Liu C, Song J, Chen Y, Liu Y, Zheng S. Prevalence and risk factors of subsyndromal delirium among postoperative patients: A systematic review and meta-analysis. J Adv Nurs 2024; 80:924-934. [PMID: 37788076 DOI: 10.1111/jan.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023]
Abstract
AIM The aim of this study is to determine the prevalence and risk factors for subsyndromal delirium in the postoperative patient. DESIGN A systematic review and meta-analysis. METHODS The Review Manager 5.3 statistics platform and the Newcastle-Ottawa Scale were used for quality evaluation. DATA SOURCES The following databases were searched: PubMed, Web of Science, EMBASE, The Cochrane Library, Scopus and EBSCO from January 2000 to December 2021. Additional sources were found by looking at relevant articles' citations. RESULTS A total of 1744 titles were originally identified, and five studies including 962 patients were included in the systematic review, with a pooled prevalence of postoperative subsyndromal delirium (PSSD) of 30% (95% CI: 0.28-0.32). Significant risk variables for PSSD were older age, low levels of education (≤9 years), cognitive impairment, higher comorbidity score, and the duration of operation. CONCLUSION PSSD is prevalent and is associated with a variety of risk factors as well as low academic performance. IMPACT Identification and clinical management of patients with PSSD should be improved. Future research on PSSD risk factors should look at a wider range of intraoperative and postoperative risk factors that can be changed. PATIENT AND PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Shunli Chen
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Lingyu Tang
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Jing Chen
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Luyao Cai
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Janying Song
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Yingyi Chen
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Yan Liu
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Silin Zheng
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Wood M, Gandhi K, Chapman A, Skippen P, Krahn G, Görges M, Stewart SE. Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study. JMIR Pediatr Parent 2023; 6:e53120. [PMID: 38091377 PMCID: PMC10734902 DOI: 10.2196/53120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Background Pediatric intensive care unit (PICU)-associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary.
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Affiliation(s)
| | | | - Andrea Chapman
- BC Children’s Hospital, VancouverBC, Canada
- Department of Psychiatry, University of British Columbia, VancouverBC, Canada
| | - Peter Skippen
- BC Children’s Hospital, VancouverBC, Canada
- Department of Pediatrics, University of British Columbia, VancouverBC, Canada
| | | | - Matthias Görges
- BC Children’s Hospital, VancouverBC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, VancouverBC, Canada
| | - S Evelyn Stewart
- BC Children’s Hospital, VancouverBC, Canada
- Department of Psychiatry, University of British Columbia, VancouverBC, Canada
- BC Mental Health and Substance Use Services Research Institute, VancouverBC, Canada
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Gao Y, Gong S, Zhou W, Li X, Gan X. Frequency and Risk Factors of Subsyndromal Delirium in the Intensive Care Units: A Prospective Cohort Study. Neuropsychiatr Dis Treat 2023; 19:1003-1016. [PMID: 37144142 PMCID: PMC10153435 DOI: 10.2147/ndt.s407156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
Background Subsyndromal delirium (SSD) is a common neuropsychiatric disorder among the intensive care units (ICU) patients. SSD is characterized by the presence of delirium symptoms but it does not meet the diagnostic criteria of delirium, resulting in poor patient prognosis. Objective The aim of this study was to explore the prevalence and risk factors for SSD among adult patients admitted to the ICU of XXX hospital in Southwest China. Methods The study participants comprised 309 patients referred to the ICU in XXX hospital between 10th August 2021 and 5th June 2022. Demographic information, medical history, and other patient information were recorded. ICDSC assessment, physical examination and laboratory tests were performed on enrolled patients. Cognitive evaluation was conducted using the MMSE method. Results The results showed that out the 309 patients, 99 had possible SSD (prevalence of 32.0%), with 55 SSD1 cases (ICDSC score of 1, 17.8% prevalence), 29 SSD2 cases (ICDSC score of 2, 9.4% prevalence) and 15 SSD3 cases (ICDSC score of 3, 4.9% prevalence). Previous history of mental illness (OR, 3.741; 95% CI, 1.136-12.324; P <0.05), auxiliary ventilation (OR, 3.364; 95% CI, 1.448-7.813; P <0.01), hemodialysis (OR, 11.369; 95% CI, 1.245-103.840; P <0.05), MMSE score (OR, 0.845; 95% CI, 0.789-0.904; P <0.001) and a temperature ≥ 37.5 °C (OR, 3.686; 95% CI, 1.404-9.732; P <0.01) were independent risk factors for occurrence of SSD among ICU patients. Conclusion Approximately one-third of the patients in the intensive care unit had high risk of SSD. Nursing staff should pay attention to management of the high-risk patients to prevent SSD from progressing delirium to improve patient prognosis.
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Affiliation(s)
- Yan Gao
- Nursing Department, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Siyuan Gong
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wen Zhou
- Nursing Department, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xia Li
- Department of Intensive Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiuni Gan
- Nursing Department, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Prevalence, risk factors, and outcomes of subsyndromal delirium in older adults in hospital or long-term care settings: A systematic review and meta-analysis. Geriatr Nurs 2022; 45:9-17. [DOI: 10.1016/j.gerinurse.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/22/2022]
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Clinical Education to Decrease Perceived Barriers to Delirium Screening in Adult Intensive Care Units. Crit Care Nurs Q 2019; 42:41-43. [PMID: 30507662 DOI: 10.1097/cnq.0000000000000235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite current advances in critical care medicine, delirium remains a frequent complication of an intensive care unit stay. The consequences can be severe and far reaching, including an increase in mortality, length of stay, and long-term cognitive sequelae. Frequently, delirium can be missed by clinicians who fail to complete a standardized delirium screening tool and, therefore, many cases go unrecognized and untreated. A multidimensional education program is one of the most effective methods to increase awareness of the condition and increase compliance in utilizing standardized delirium screening tools at the bedside.
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Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, Joyce C, Greenwald BM. Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium. Crit Care Med 2017; 45:891-898. [PMID: 28288026 PMCID: PMC5392157 DOI: 10.1097/ccm.0000000000002324] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay. DESIGN Prospective, longitudinal cohort study. SETTING Urban academic tertiary care PICU. PATIENTS All consecutive admissions from September 2014 through August 2015. INTERVENTIONS Children were screened for delirium twice daily throughout their ICU stay. MEASUREMENTS AND MAIN RESULTS Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). Seventy-eight percent of children with delirium developed it within the first 3 PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU length of stay was increased in children with delirium (adjusted relative length of stay, 2.3; CI = 2.1-2.5; p < 0.001), as was duration of mechanical ventilation (median, 4 vs 1 d; p < 0.001). Delirium was a strong and independent predictor of mortality (adjusted odds ratio, 4.39; CI = 1.96-9.99; p < 0.001). CONCLUSIONS Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.
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Affiliation(s)
- Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Gabrielle Silver
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Savneet Kaur
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Elizabeth A. Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Abigail Kerson
- (no department – medical student), Weill Cornell Medical College, New York, NY
| | - Christine Joyce
- Department of Pediatrics, New York Presbyterian Hospital, New York, NY
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The authors reply. Crit Care Med 2016; 44:e1152. [DOI: 10.1097/ccm.0000000000002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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