Evaluating the Association Between Delirium in the Intensive Care Unit and Subsequent Neuropsychiatric Disorders Post-Stay
Date
2018-08-03
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Abstract
Individuals without pre-existing neuropsychiatric disorders are reported to be at increased risk of developing a neuropsychiatric disorder after admission to an Intensive Care Unit (ICU). This risk may be attributed to the severity of illness and the nature of therapies provided, including intubation, medically induced coma, and numerous medications. Furthermore, approximately half of ICU patients develop delirium during their stay, which may further add to the burden of neuropsychiatric disorders experienced by these patients. If delirium is not identified and treatment initiated early, patients may be at risk for adverse consequences, such as increased mortality, increased length of hospital stay and further cognitive impairment. Therefore, the objectives of this thesis were to (1) examine the overall prevalence and (2) incidence of neuropsychiatric disorders following a stay in a general systems ICU; and (3) determine the association between delirium in the ICU and an onset of a neuropsychiatric disorders subsequent to the ICU stay. The objectives for this study were addressed in two phases. In phase one, a systematic review and meta-analysis was conducted to address the overall pooled prevalence of depression, anxiety, trauma-and-stressor related, and neurocognitive disorders. Based on the analysis, the overall pooled prevalence of the disorders was: 32% (95% Confidence Interval [CI] 25%-39%), 32% (95% CI 24%-40%), 23% (95% CI 18%- 28%), and 42% (95% CI 25%-60%), respectively. The systematic review revealed a significant association between delirium and neuropsychiatric disorders (specifically trauma-and-stressor related and neurocognitive disorders). In phase two, a retrospective cohort study using administrative databases was conducted. The cumulative incidence for depressive, anxiety, trauma-and-stressor related, and neurocognitive disorders were: 10.6%, 8.9%, 2.5%, and 3.7%, respectively. The study results suggested that for patients who ever had delirium in the ICU, there was a 1.23 times the risk of developing any neuropsychiatric disorder compared to those who never had delirium in the ICU. Early treatment of delirium may be necessary to reduce the morbidity of delirium and possibly the subsequent development of neuropsychiatric disorders post-ICU stay.
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Keywords
Systematic review, meta-analysis, retrospective cohort, intensive care, neuropsychiatric disorders
Citation
Brown, K. N. (2018). Evaluating the Association Between Delirium in the Intensive Care Unit and Subsequent Neuropsychiatric Disorders Post-Stay (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/32791