Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Peritogiannis, Vaios; Bolosi, Maria; Lixouriotis, Charalampos; Rizos, Dimitrios

doi:10.1155/2015/416792

Cited by 60 publications

(36 citation statements)

References 76 publications

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“…It is important to note that, as in adults, only a minority of delirium was of the easily recognizable hyperactive subtype(1,25,26). In adults, hypoactive delirium is thought to be the most severe form of delirium, with worse prognostic implications(27).…”

Section: Discussionmentioning

confidence: 99%

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

Traube

Silver

Gerber

et al. 2017

Critical Care Medicine

284

254

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Objective 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 incidence 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 (MV), and length of hospital stay (LOS). Design Prospective longitudinal cohort study. Setting Urban academic tertiary care pediatric intensive care unit (PICU). Patients All consecutive admissions from September 2014 through August 2015. Intervention Children were screened for delirium twice daily throughout their ICU stay. Measurements and Main Results Of 1547 consecutive patients, delirium was diagnosed in 267 (17%), and lasted a median of two days (IQR 1,5). Seventy-eight percent of children with delirium developed it within the first three 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 ≤2 years, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU LOS was increased in children with delirium (adjusted relative LOS 2.3, CI= 2.1, 2.5, p<0.001), as was duration of MV (median 4 vs. 1 day, p<0.001). Delirium was a strong and independent predictor of mortality (adjusted OR 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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Section: Discussionmentioning

confidence: 99%

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

Traube

Silver

Gerber

et al. 2017

Critical Care Medicine

284

254

View full text Add to dashboard Cite

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“…We also explored the ability of MMSE domains to predict delirium types, hypoactive delirium versus hyperactive delirium [31]. …”

Section: Introductionmentioning

confidence: 99%

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery

Price

Garvan

Hizel

et al. 2017

JAD

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Background Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. Our goal was to determine if certain cognitive domains from the general cognitive screener- the Mini Mental State Exam (MMSE) - predict delirium after cardiac surgery. Method Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery. Following surgery, delirium was assessed throughout ICU stay using the Confusion Assessment Method for ICU delirium and the Richmond Agitation and Sedation Scale. Results Cardiac surgery patients who developed delirium (n=137) had lower total MMSE scores than patients who did not develop delirium (n=457). In particular, orientation to place, working memory, delayed recall, and language domain scores were lower. Of these, only the working memory and delayed recall domains predicted delirium in a regression model adjusting for history of chronic obstructive pulmonary disease, age, sex, and duration of cardiopulmonary bypass. For each word not recalled on the three-word delayed recall assessment, the odds of delirium increased by 50%. For each item missed on the working memory index, the odds of delirium increased by 36%. Of the patients who developed delirium, 47% had a primary impairment in memory, 21% in working memory, and 33% in both domains. The area under the receiver operating characteristics curve using only the working memory and delayed recall domains was 0.75, compared to 0.76 for total MMSE score. Conclusion Delirium risk is greater for individuals with reduced MMSE scores on the delayed recall and working memory domains. Research should address why patients with memory and executive vulnerabilities are more prone to postoperative delirium than those with other cognitive limitations.

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“…Zu beachten ist, dass diese Medikamente vor allem bei einer hyperaktiven Delir-Symptomatik indiziert sind. Etwa ein Drittel der Patienten weist ein hypoaktives Delir auf [13,14], hier werden die medikamentöse Therapiestrategien jedoch uneinheitlich beurteilt [10,15]. Für die im ambulanten Versorgungssektor durchgeführte Psychopharmakotherapie des Delirs sind keine nationalen oder internationalen pharmako-epidemiologischen Studien bekannt.…”

Section: Introductionunclassified

Inzidenz und Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- und Facharztpraxen

Bohlken

Hewer

Kostev³

2018

Fortschr Neurol Psychiatr

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Zusammenfassung Ziel Über die Häufigkeit und die medikamentöse Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- (HA) und Facharzt-Praxen (FA) ist wenig bekannt. Ziel der Studie war die Bestimmung der Delir-Inzidenz und der Delir-Behandlung mit Neuroleptika und Benzodiazepinen in HA.- und FA-Praxen. Methoden In dem Zeitraum von 2012 bis 2015 wurden 2.999 Patienten > 65 Jahre in 1.262 HA- und 1.425 Patienten in 203 FA-Praxen mit erstmaliger Delir-Diagnose (ICD 10: F05) ausgewählt und hinsichtlich der Verordnung von Neuroleptika (EphMRA ATC: N05A) und Benzodiazepine (N06C) untersucht, die direkt nach der Diagnosestellung des Delirs erfolgte. Ergebnisse Die kumulative 1-Jahres-Inzidenz des Delirs betrug in HA-Praxen 0,6 und in FA-Praxen 1,9 Patienten pro Praxis. Keine Delir-Diagnose wurde in mehr als 40 % der Praxen gestellt. Im Heim erfolgte die Behandlung bei 31 % der HA- und 21 % der FA Patienten. Häufigste HA-Verordnung: Melperon (9,4 % zu Hause bzw. 13,7 % im Heim), FA: Risperidon (4,3 % zu Hause bzw. 13,4 % im Heim). Die antidelirante Medikation war positiv mit männlichem Geschlecht (OR = 1.26), Wohnen im Seniorenheim (OR = 1,74) Demenz (OR = 1.55) und Depression (OR = 1.32), und negativ mit FA-Behandlung (OR = 0.73) assoziiert. Schlussfolgerung Die Delir-Diagnose und seine medikamentöse Behandlung ist in deutschen Arzt-Praxen ein relativ seltenes Ereignis. Die Ursachen für die im internationalen Vergleich niedrige Prävalenzrate im ambulanten Versorgungsbereich sollte intensiver untersucht werden.

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Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Cited by 60 publications

References 76 publications

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery

Inzidenz und Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- und Facharztpraxen

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