A call to action for delirium research: Meta-analysis and regression of delirium associated mortality

Abstract

Background Delirium is an extremely common hospital complication. No study to date has assessed whether a priori defined covariates; type of hospital setting and year of study publication, influence the relationship between delirium and mortality. This is also the first study to examine the longitudinal trend of delirium-associated mortality over recent decades, to analyse the trajectory of our efforts in combating this disease. Methods MEDLINE, EMBASE and PsycINFO, were searched from January 1981 to May 2018 for English-language primary articles. Rigorous title and abstract screen and full-text screen were conducted independently by two reviewers. This paper adhered to MOOSE guidelines. Data was extracted independently by one reviewer using standardised data-collection sheets, with a separate reviewer verifying for accuracy. The quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Unadjusted effect sizes and event counts were analysed with a random effects model in primary meta-analysis and meta-regression, whereas a mixed effect model was used in secondary sub-group analysis. Mortality data at longest follow-up and cumulative mortality (hospital mortality combined with mortality at longest follow-up) data were analysed. Results As part of a larger project, 446 of 6790 articles were retrieved, including 71 studies that measured mortality. Our results demonstrate that elderly inpatients with delirium had significantly greater odds of mortality (OR 3.18 [95%CI: 2.73, 3.70]) compared to non-delirious controls. Patients with delirium in the ICU had the highest odds for mortality (OR: 7.09 [95%CI: 3.60, 14.0]); double the risk compared to the average. Curiously, despite advancements in delirium research, delirium associated in-hospital odds of mortality has not changed in 30 years. Conclusion This is the largest meta-analysis to confirm the association between delirium and mortality, in older (age ≥ 65) hospital inpatients. The current meta-analysis highlights the significant odds of mortality after an episode of delirium, and these odds are much higher for ICU patients. However, in contrast to other medical conditions that have seen a decrease in associated mortality over the past few decades, delirium associated mortality remains unchanged. These findings underscore the urgent need for better delirium treatments. PROSPERO Registration Number: CRD42018098627, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=98627

In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre

“…Further, in line with a previous study including a triggered geriatric consult model, we achieved improved diagnosis and documentation of delirium [47]. While often underdiagnosed in the absence of proactive monitoring [48], delirium is associated with long-term cognitive decline and increased mortality in both surgical and nonsurgical patients [49,50]. Our higher detection rate of delirium after the implementation of OGCM is in line with previous studies [39,51,52].…”

Survival of Frail Elderly with Delirium

“…Contrary to other medical conditions, delirium-associated mortality has remained unchanged in recent decades [ 32 ]. The onset of delirium increases the long-term mortality risk after intensive care unit (ICU) survival [ 33 , 34 , 35 , 36 , 37 ] and hospital discharge [ 38 ], while the core symptoms of delirium increase the mortality risk for older people by themselves [ 39 ].…”

Consensus for the management of analgesia, sedation and delirium in adults with COVID-19-associated acute respiratory distress syndrome

“…Importantly, its appearance in patients admitted to the ICU is associated with a higher mortality rate. ( 79 ) It should be borne in mind that there is no pharmacological treatment that has proven effective for managing delirium ; therefore, prevention is essential. ( 15 ) Delirium is especially high in mechanically ventilated patients with COVID-19, reaching up to 75%, and confusion was the fifth most frequent characteristic of these patients in the United Kingdom.…”