Factors Influencing Delirium in Neurological Intensive Care Unit Patient

Hyun Jin Lee; Sung Reul Kim

doi:10.7475/kjan.2018.30.5.470

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Lee and Kim: Factors Influencing Delirium in Neurological Intensive Care Unit Patient

Original Article

Korean Journal of Adult Nursing 2018; 30(5): 470-481.

Published online: 25 October 2018

DOI: https://doi.org/10.7475/kjan.2018.30.5.470

Factors Influencing Delirium in Neurological Intensive Care Unit Patient

Hyun Jin Lee¹

, Sung Reul Kim²

¹RN, Department of Nursing, Chonbuk National University Hospital, Jeonju, Korea.

²Associate Professor, College of Nursing, Korea University, Seoul, Korea.

Corresponding author: Kim, Sung Reul. College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea. Tel: +82-2-3290-4929, Fax: +82-2-928-9107, srkim74@korea.ac.kr

Received 18 May 2018 Revised 6 June 2018 Accepted 2 July 2018

Korean Society of Adult Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aims of this study were to describe the incidence rate of delirium and to identify factors influencing delirium in neurological intensive care unit patients.

Methods

The participants were 193 critically ill patients with neurological disorder from Chonbuk national university hospital in Jeonju. Data were collected between April 1 and November 25, 2017 using four structured questionnaires: Confusion Assessment Method for the Intensive Care Unit, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Karnofsky Performance Scale. Data were analyzed using descriptive statistics, independent t-test, χ² test, Mann-Whitney U test, and logistic regression using the SPSS/WIN 24.0 program.

Results

The incidence rate of delirium was 11.9%. Delirium was related with age, length of stay in intensive care unit, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation II score, Karnofsky Performance Scale score, use of physical restraint, antihypertensive drugs, and anticonvulsants. Logistic regression analysis showed that age, length of stay in intensive care unit, use of physical restraint, and anticonvulsants were factors influencing delirium in neurological intensive care unit patients.

Conclusion

Delirium was related to demographic, clinical, medication-related, and environmental factors in patients in neurological intensive care units. Therefore, nurses should consider the patient's age, length of stay intensive care unit, use of physical restraint, and anticonvulsants in assessing delirium in neurological intensive care unit patients. Delirium prevention programs considering these factors may be effective for such patients.

Keywords: Critical illness, Delirium, Intensive care units, Nervous system diseases, Patients

Figures and Tables

Table 1

Comparison of Demographic and Clinical Characteristics between the Delirium and Non-delirium Groups (N=193)

ICU=intensive care unit; GCS=Glasgow Coma Scale; APACHE II=Acute Physiology and Chronic Health Evaluation II; CNS=central nervous system; ^†Fisher's exact test; ^‡Mann-Whitney U test.

Table 2

Comparison of Hematological Characteristics between the Delirium and Non-delirium Groups (N=193)

WBC=white blood cell; RBC=red blood cell; ESR=erythrocyte sedimentation rate; CRP=C-reactive protein; AST=aspartate transaminase; ALT=alanine transaminase; BUN=blood urea nitrogen; T4=thyroxine; TSH=thyroid stimulating hormone; pH=hydrogen ion concentration; SPaO₂=alveolo-arterial saturation by pulse oximetry; ^†Fisher's exact test.

Table 3

Comparison of Drug Related Characteristics between the Delirium Group and Non-delirium Groups (N=193)

^†Fisher's exact test; ^‡Mann-Whitney U test.

Table 4

Comparison of Physical and Environmental Characteristics between the Delirium and Non-delirium Groups (N=193)

BMI=body mass index; KPS=Karnofsky Performance Scale; ^†Fisher's exact test.

Table 5

Factors Influencing Delirium by Stepwise Logistic Regression in Neurological Intensive Care Unit Patients (N=193)

ICU=intensive care unit; OR=odds ratio; CI=confidence interval; SE=standard error.

ACKNOWLEDGEMENT

This article is based on a part of the first author's master's thesis from Chonbuk National University

Notes

^{CONFLICTS OF INTEREST} The authors declared no conflict of interest.

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ORCID iDs

Hyun Jin Lee
https://orcid.org/0000-0002-1740-8462

Sung Reul Kim
https://orcid.org/0000-0002-1768-0829

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