Differential Clinical Characteristics, Management, and Outcome of Delirium among Ward Compared with ICU Patients.

Abstract

Delirium is common in hospitalized patients but its epidemiology remains poorly characterized. To test the hypothesis that patient demographics, clinical phenotype, management, and outcomes of patient with delirium in hospital ward patients differ from ICU patients. Retrospective cohort of patients admitted to an Australian university-affiliated hospital between March 2013 and April 2017 and coded for delirium at discharge using the ICD-10 criteria. Among 61,032 hospitalized patients, 2,864 (4.7%) were coded for delirium. From these, we studied a random sample of 100 ward patients and 100 ICU patients. Ward patients were older (median age: 84 vs. 65 years; P<0.0001), more likely to have dementia (38% vs. 2% for ICU patients; P<0.0001) and less likely to have had surgery (24 vs. 62%; P<0.0001). Of ward patients, 74% had hypoactive delirium, while 64% of ICU patients had agitated delirium (P<0.0001). Persistent delirium at hospital discharge was more common among ward patients (66% vs 17%, p<0.0001). On multivariable analysis, age and dementia predicted persistent delirium, while surgery predicted recovery. Delirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia, and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection, and goals of care should be adapted to the environment in which it occurs. This article is protected by copyright. All rights reserved.