Outcome of delirium in critically ill patients: systematic review and meta-analysis

Jorge I F Salluh; Han Wang; Eric B Schneider; Neeraja Nagaraja; Gayane Yenokyan; Abdulla Damluji; Rodrigo B Serafim; Robert D Stevens

doi:10.1136/bmj.h2538

Outcome of delirium in critically ill patients: systematic review and meta-analysis

BMJ. 2015 Jun 3:350:h2538. doi: 10.1136/bmj.h2538.

Authors

Jorge I F Salluh¹, Han Wang², Eric B Schneider², Neeraja Nagaraja², Gayane Yenokyan³, Abdulla Damluji⁴, Rodrigo B Serafim⁵, Robert D Stevens⁶

Affiliations

¹ D'OR Institute for Research and Education, Rio de Janeiro, Brazil.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Elaine and Sydney Sussman Cardiac Catheterization Laboratories, Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA.
⁵ D'OR Institute for Research and Education, Rio de Janeiro, Brazil Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
⁶ Department of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Abstract

Objectives: To determine the relation between delirium in critically ill patients and their outcomes in the short term (in the intensive care unit and in hospital) and after discharge from hospital.

Design: Systematic review and meta-analysis of published studies.

Data sources: PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, with no language restrictions, up to 1 January 2015.

Eligibility criteria for selection studies: Reports were eligible for inclusion if they were prospective observational cohorts or clinical trials of adults in intensive care units who were assessed with a validated delirium screening or rating system, and if the association was measured between delirium and at least one of four clinical endpoints (death during admission, length of stay, duration of mechanical ventilation, and any outcome after hospital discharge). Studies were excluded if they primarily enrolled patients with a neurological disorder or patients admitted to intensive care after cardiac surgery or organ/tissue transplantation, or centered on sedation management or alcohol or substance withdrawal. Data were extracted on characteristics of studies, populations sampled, identification of delirium, and outcomes. Random effects models and meta-regression analyses were used to pool data from individual studies.

Results: Delirium was identified in 5280 of 16,595 (31.8%) critically ill patients reported in 42 studies. When compared with control patients without delirium, patients with delirium had significantly higher mortality during admission (risk ratio 2.19, 94% confidence interval 1.78 to 2.70; P<0.001) as well as longer durations of mechanical ventilation and lengths of stay in the intensive care unit and in hospital (standard mean differences 1.79 (95% confidence interval 0.31 to 3.27; P<0.001), 1.38 (0.99 to 1.77; P<0.001), and 0.97 (0.61 to 1.33; P<0.001), respectively). Available studies indicated an association between delirium and cognitive impairment after discharge.

Conclusions: Nearly a third of patients admitted to an intensive care unit develop delirium, and these patients are at increased risk of dying during admission, longer stays in hospital, and cognitive impairment after discharge.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Cognition Disorders / mortality
Cognition Disorders / psychology
Critical Care / statistics & numerical data
Critical Illness / mortality
Critical Illness / psychology*
Delirium / mortality
Delirium / therapy*
Epidemiologic Methods
Female
Humans
Length of Stay / statistics & numerical data
Male
Patient Discharge / statistics & numerical data
Respiration, Artificial / mortality
Treatment Outcome