Impact of Delirium on Clinical Outcomes in Intensive Care Unit Patients: An Observational Study in a Korean General Hospital

Jeong-Hyun Sohn; Se-Hee Na; Cheung Soo Shin; Injung Sohn; Joo-Young Oh; Ji-sun An; Suk-Kyoon An; Jae-Jin Kim; Jin Young Park

doi:10.4306/jknpa.2014.53.6.418

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Sohn, Na, Shin, Sohn, Oh, An, An, Kim, and Park: Impact of Delirium on Clinical Outcomes in Intensive Care Unit Patients: An Observational Study in a Korean General Hospital

Original Article

Journal of Korean Neuropsychiatric Association 2014; 53(6): 418-425.

Published online: 30 November 2014

DOI: https://doi.org/10.4306/jknpa.2014.53.6.418

Impact of Delirium on Clinical Outcomes in Intensive Care Unit Patients: An Observational Study in a Korean General Hospital

Jeong-Hyun Sohn, MD^1,², Se-Hee Na, MD, PhD³, Cheung Soo Shin, MD, PhD³, Injung Sohn, MD², Joo-Young Oh, MD^2,⁴, Ji-sun An, MD², Suk-Kyoon An, MD, PhD^2,⁵, Jae-Jin Kim, MD, PhD^2,⁶, Jin Young Park, MD, PhD^2,⁶

¹Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

²Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.

³Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

⁴Department of Medical System Engineering (DMSE), Gwangju Institute of Science and Technology (GIST), Gwangju, Korea.

⁵Department of Psychiatry, Severance Mental Health Hospital, Yonsei University College of Medicine, Gwangju, Korea.

⁶Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Jin Young Park, MD, PhD. Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel +82-2-2019-3341, Fax +82-2-3462-4304, empathy@yuhs.ac

Received 21 July 2014 Revised 15 August 2014 Accepted 2 September 2014

Abstract

Objectives

The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital.

Methods

All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness.

Results

The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates.

Conclusion

The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.

Keywords: Intensive care unit, Delirium, Length of stay, Mortality, Clinical outcome

Figures and Tables

Fig. 1

Flow chart of inclusion for delirium study in ICU patients. ICU : Intensive care unit, RASS : Richmond Agitation-Sedation Scale.

Table 1

Baseline characteristics of the patients

^*: By independent-sample t-test, ^†: By Pearson's chi-square test, ^‡: ≥Mean +2 standard deviation day (length of stay) : ≥98 hospital days or ≥28 ICU days, total 23 patients, 4 overlapped, ^§: Indicates Pearson χ² (chi-square) for male, surgery, emergency admission, extremely long admission (overall), extremely long admission (ICU) ; indicates t for age, APACHE-II score. APACHE-II : Acute Physiology and Chronic Health Evaluation-II, ICU : Intensive care unit, SD : Standard deviation

Table 2

Association between delirium and outcome variables (mortality, ICU-stay, HOD^*)

^*: p<0.001, ^†: By Pearson's chi-square test, ^‡: By independent-sample t-test, ^§: 585 patients included after 14 (delirium 12, no delirium 2) subjects excluded for extremely long admission for ICU, ^∥: 586 patients included after 13 (delirium 9, no delirium 4) subjects excluded for extremely long admission for hospital, ^¶: Indicates Pearson χ² (chi-square) for mortality ; indicates t for ICU-stay, HOD. HOD : Hospital day, ICU : Intensive care unit, SD : Standard deviation

Table 3

Association between delirium and outcome variables after adjusted for covariates^*^†

^*: Adjusted for type of admission, surgery, APACHE-II score (Acute Physiology and Chronic Health Evaluation-II), age by analysis of covariance, ^†: 81 (delirium 24, no delirium 57) subjects missing APACHE-II score on medical records were excluded among 598 subjects, ^‡: Total 505 patients included finally after 12 (delirium 10, no delirium 2) subjects excluded for extremely long admission for ICU, ^§: Total 510 patients included finally after 7 (delirium 5, no delirium 2) subjects excluded for extremely long admission for hospital. HOD : Hospital day

Notes

The authors have no financial conflicts of interest.

Appendix

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