Risk factors for the incidence of delirium in cerebrovascular patients in a Neurosurgery Intensive Care Unit: A prospective study

Abstract

Aims and objectives To explore the incidence of delirium in cerebrovascular patients admitted in our Neurosurgery Intensive Care Unit and analyse the risk factors leading to delirium. Background Delirium is one of the most common mental disorders in general hospitals, but the incidence of different kinds of diseases and studies varies. Cerebrovascular patients in our Neurosurgery Intensive Care Unit are high‐risk groups for delirium; identifying risk factors for delirium and taking early interventions are crucial for patient prognosis. Design A prospective study. Methods A convenience sampling method was used to collect data from 128 patients in the Neurosurgery Intensive Care Unit of Xuanwu Hospital, Capital Medical University, Beijing, China, between May 2016–January 2017. Researchers used Confusion Assessment Method for the Intensive Care Unit (Chinese version) to assess each patient's delirium statement twice a day at regular times. We also collected other independent data variables and followed up the short‐term clinical outcomes daily. Results On the basis of Confusion Assessment Method for the Intensive Care Unit evaluation, patients were divided into a delirium group and a nondelirium group. The prevalence of delirium among the 128 patients was 42.2%. Multivariate analysis showed that severity of illness, fever, the use of physical restraints and sleep deprivation were independent predictors of delirium in cerebrovascular patients in the Neurosurgery Intensive Care Unit. Conclusions Cerebrovascular patients in the Neurosurgery Intensive Care Unit with a critical condition, fever or use of physical restraints or experiencing sleep deprivation were more prone to delirium. Relevance to clinical practice Cerebrovascular patients in the Neurosurgery Intensive Care Unit showed a high incidence of delirium. There are many risk factors leading to delirium, some of which are independent predictors of intensive care delirium. Patients with delirium will suffer various adverse effects upon their short‐term clinical outcomes. Therefore, nurses should pay close attention to changes in a patient's mental state and learn about the risk factors associated with delirium, in order to be able to take early measures to prevent delirium.

<p>Risk factors for delirium: are therapeutic interventions part of it?</p>

“…The prevalence of delirium reported in these publications ranges from 24% to 42% 23–26. In the present study, the incidence of delirium was 28.75% (92 in 320 patients), which is generally consistent with these reports enrolling Chinese populations 23–26…”

“…Risk factors for delirium have gradually drawn the clinicians and researchers’ attention in China. Therefore, relative reports increase obviously in recent years 23–26. The prevalence of delirium reported in these publications ranges from 24% to 42% 23–26.…”

Delirium in neurosurgery: a systematic review and meta-analysis

“…Two RCTs, seven prospective and eleven retrospective cohort studies were included. Disease type for patients undergoing intracranial surgery were categorized in mixed (33.9%, n p = 1478), [4,10,21,32,39,[41][42][43][44][45][46][47][48] functional neurosurgery (26.8%, n p = 552), [11,46,[49][50][51] neurovascular (10.5%, n p = 145), [52][53][54] neuro-oncology (18.4%, n p = 1969) [5,7,55], traumatic brain injury (TBI) (4.3%, n p = 27) [56,57] and microvascular decompression (MVD) (6.2%, n p = 912) [9]. The mixed group included neurovascular, neuro-oncologic, TBI or hydrocephalus operations and functional neurosurgery (solely deep brain stimulation (DBS) in patients with Parkinson's disease).…”

“…requiring removal) [10, 21, 39, 44, 46-48, 52, 54, 56, 57]. Six studies did not report age, and seven studies did not report gender within the intracranial operated cohort [45,[47][48][49][52][53][54]. Pooled age in years (mean/SD, n s = 14) [4, 5, 7, 9-11, 32, 44, 46, 49-51, 55, 56] and percentage of males (n s = 13) [5, 7, 9-11, 32, 44, 46, 50, 51, 55, 56] of the remaining studies were 60.32% (4.47) and 49.6%, respectively.…”

Establishment and validation of a delirium prediction model for neurosurgery patients in intensive care

“…Patients with delirium are at high risk of experiencing additional complications, prolonged hospital stays, increased hospital costs, and in-hospital mortality. Moreover, delirium is associated with negative clinical outcomes and also has long-term effects on patients with decreased cognitive functions including reduced quality of life and even lower survival rates (Wang et al, 2018;Wolters, Van, Cremer, De, & Slooter, 2013). Therefore, accurate diagnosis of delirium can promote effective prevention and early treatment, thereby preventing unfavourable consequences of this condition.…”