title: Association between combative behavior requiring intervention and delirium in hospitalized patients.
abstract: BACKGROUND
  We hypothesized that delirium contributes to combative behavior requiring intervention in hospitalized patients. Delirium identification would therefore potentially provide an opportunity for prevention and early identification of patients at risk, thereby improving safety for patients and staff.
  
  
  OBJECTIVE
  To determine whether delirium is associated with combative behavior requiring intervention in a general hospital population.
  
  
  METHODS
  Case control study.
  
  
  METHODS
  A 336-bed, nonuniversity, teaching hospital serving adults in the Pacific Northwest.
  
  
  METHODS
  One hundred twenty consecutive hospitalized patients with combative behavior requiring intervention compared to 159 randomly selected inpatient control subjects, all from 2011.
  
  
  METHODS
  Bivariate statistics were used to compare demographics; diagnoses; presence of delirium, dementia, substance use, other psychiatric diagnosis; medications; hospital length of stay; and discharge disposition. We used stepwise logistic regression to determine the association of combative behavior requiring intervention with delirium after adjustment for covariates.
  
  
  RESULTS
  Delirium preceding the combative behavior was present in 50% (60/120) of patients with combative behavior requiring intervention compared to 16% (26/159) of controls (P < 0.001). Combative-behavior patients were hospitalized longer (9.4 vs 4.5 days, P < 0.001), and were more likely to be discharged to a skilled nursing facility (26%, 31/120) or to leave against medical advice (10%, 12/120, P < 0.001). Delirium was strongly associated with combative behavior requiring intervention, after adjustment (odds ratio: 3.8, 95% confidence interval: 2.0-7.3, P < 0.001).
  
  
  CONCLUSIONS
  Delirium is strongly associated with combative behavior requiring intervention, which poses a significant safety risk for patients and staff.
authors.affiliation: Department of Psychiatry, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Karina
authors.initials: K
authors.lastname: Uldall
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Williams
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Dunn
authors.forename: C Craig
authors.initials: CC
authors.lastname: Blackmore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D016022:Case-Control Studies; D003693:Delirium / Q000453:epidemiology* / Q000523:psychology*; D006784:Hospitals, Teaching; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D010351:Patient Discharge / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics