title: Effects of routine monitoring of delirium in a surgical/trauma intensive care unit.
abstract: BACKGROUND
  Delirium is prevalent in surgical and trauma intensive care units (ICUs) and carries substantial morbidity. This study tested the hypothesis that daily administration of a diagnostic instrument for delirium in a surgical/trauma ICU decreases the time of institution of pharmacologic therapy and improves related outcomes.
  
  
  METHODS
  Controlled trial of two concurrent groups. The Confusion-Assessment Method for ICU was administered daily to all eligible patients admitted to our surgical/trauma ICU for 48 hours or longer. The result was communicated to one of the two preexisting ICU services (intervention service) and not the other (control service). Primary outcome was the time between diagnosis of delirium and pharmacologic treatment. Secondary outcomes included duration of delirium, mechanical ventilation, and ICU stay.
  
  
  RESULTS
  Delirium occurred in 98 (35%) of 283 consecutive patients. Time between diagnosis and therapy did not differ between intervention (35 [35] hours) and control (40 [41] hours) groups. There was a difference in the number of delirium days treated in the intervention (73%) versus control (64%) groups (p = 0.035). The intervention group had significantly lower odds to neglect treating delirium when delirium was present (odds ratio, 0.67; 95% confidence interval, 0.45-1.00; p = 0.05). In the subgroup of trauma patients, the odds ratio of negligence was 0.37 (95% confidence interval, 0.14-0.99; p = 0.048), indicating lower probability for trauma patients to be untreated. There was no difference in the average duration of delirium, mechanical ventilation, and ICU stay.
  
  
  CONCLUSIONS
  In our surgical/trauma ICU, daily screening for delirium did not affect the timing of pharmacologic therapy. Although the intervention resulted in a higher number of delirious ICU patients being treated, particularly trauma patients, there was no effect on related outcomes.
  
  
  METHODS
  Therapeutic study, level IV.
authors: Department of Anesthesiology and Pain Medicine, Tufts University School of Medicine, Newton, Massachusetts 02135, USA. luca.bigatello@Steward.org
authors: Luca M
authors: LM
authors: Bigatello
authors: Houman
authors: H
authors: Amirfarzan
authors: Asieh Kazem
authors: AK
authors: Haghighi
authors: Beverly
authors: B
authors: Newhouse
authors: J Mauricio
authors: JM
authors: Del Rio
authors: Kathrin
authors: K
authors: Allen
authors: Anne
authors: A
authors: Chang
authors: Ulrich
authors: U
authors: Schmidt
authors: Moaven
authors: M
authors: Razavi
mesh_terms: D000368:Aged; D003693:Delirium / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D015995:Prevalence; D012121:Respiration, Artificial; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications / Q000601:surgery*