title: Delirium epidemiology in critical care (DECCA): an international study.
abstract: BACKGROUND
  Delirium is a frequent source of morbidity in intensive care units (ICUs). Most data on its epidemiology is from single-center studies. Our aim was to conduct a multicenter study to evaluate the epidemiology of delirium in the ICU.
  
  
  METHODS
  A 1-day point-prevalence study was undertaken in 104 ICUs from 11 countries in South and North America and Spain.
  
  
  RESULTS
  In total, 975 patients were screened, and 497 fulfilled inclusion criteria and were enrolled (median age, 62 years; 52.5% men; 16.7% and 19.9% for ICU and hospital mortality); 64% were admitted to the ICU because of medical causes, and sepsis was the main diagnosis (n = 76; 15.3%). In total, 265 patients were sedated with the Richmond agitation and sedation scale (RASS) deeper than -3, and only 232 (46.6%) patients could be evaluated with the confusion-assessment method for the ICU. The prevalence of delirium was 32.3%. Compared with patients without delirium, those with the diagnosis of delirium had a greater severity of illness at admission, demonstrated by higher sequential organ-failure assessment (SOFA (P = 0.004)) and simplified acute physiology score 3 (SAPS3) scores (P < 0.0001). Delirium was associated with increased ICU (20% versus 5.7%; P = 0.002) and hospital mortality (24 versus 8.3%; P = 0.0017), and longer ICU (P < 0.0001) and hospital length of stay (LOS) (22 (11 to 40) versus 7 (4 to 18) days; P < 0.0001). Previous use of midazolam (P = 0.009) was more frequent in patients with delirium. On multivariate analysis, delirium was independently associated with increased ICU mortality (OR = 3.14 (1.26 to 7.86); CI, 95%) and hospital mortality (OR = 2.5 (1.1 to 5.7); CI, 95%).
  
  
  CONCLUSIONS
  In this 1-day international study, delirium was frequent and associated with increased mortality and ICU LOS. The main modifiable risk factors associated with the diagnosis of delirium were the use of invasive devices and sedatives (midazolam).
authors.affiliation: Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, 10° Andar; Praça Cruz Vermelha, 23; Rio de Janeiro-RJ; CEP: 20230-130, Brazil. jorgesalluh@yahoo.com.br
authors.forename: Jorge I
authors.initials: JI
authors.lastname: Salluh
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
authors.forename: José M
authors.initials: JM
authors.lastname: Teles
authors.forename: Daniel
authors.initials: D
authors.lastname: Ceraso
authors.forename: Nestor
authors.initials: N
authors.lastname: Raimondi
authors.forename: Victor S
authors.initials: VS
authors.lastname: Nava
authors.forename: Patrícia
authors.initials: P
authors.lastname: Blasquez
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ugarte
authors.forename: Carlos
authors.initials: C
authors.lastname: Ibanez-Guzman
authors.forename: José V
authors.initials: JV
authors.lastname: Centeno
authors.forename: Manuel
authors.initials: M
authors.lastname: Laca
authors.forename: Gustavo
authors.initials: G
authors.lastname: Grecco
authors.forename: Edgar
authors.initials: E
authors.lastname: Jimenez
authors.forename: Susana
authors.initials: S
authors.lastname: Árias-Rivera
authors.forename: Carmelo
authors.initials: C
authors.lastname: Duenas
authors.forename: Marcelo G
authors.initials: MG
authors.lastname: Rocha
mesh_terms: D000368:Aged; D003422:Critical Care / Q000639:trends*; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D038622:Internationality; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012307:Risk Factors; D013020:South America / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology