ICU delirium, clinical outcomes and cost: systematic review &meta-analysis
CCCF ePoster library. Herritt B. Oct 2, 2017; 198202; 35
Dr. Brent Herritt
Dr. Brent Herritt
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Abstract
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ICU delirium, clinical outcomes and cost: systematic review &meta-analysis

Kyeremanteng, Kwadwo 1,2

Bhardwaj, Kalpana 1,2

Chaudhuri, Dipayan 1,2

Herritt, Brent 1,2

Lawlor, Peter 1,2

Bush, Shirley 1,2

Kanji, Salmaan 1,2

Tanuseputro, Peter 1,2

Rosenberg, Erin 1,2



1. University of Ottawa,

2. The Ottawa Hospital 



 


Objectives
To investigate the association between delirium and duration of mechanical ventilation in patients with delirium. The primary outcome is Intensive Care Unit Length of Stay (ICU LOS). The secondary outcomes are hospital LOS, an association between delirium and mortality in the ICU or the hospital and cost-effectiveness.
Design
Systematic review and meta-analysis of published studies. Update on previous systematic review and meta-analysis by Salluh et al. 2015.
 
Data sources
PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, without language criteria, up to October 2016.
 
Eligibility criteria for selection studies
The additional studies were included from January 2015 to October 2016, where patients were adults only and were evaluated for delirium with a validated screening or diagnostic instrument. The included studies reported the ICU LOS. Two reviewers independently screened citations, reviewed studies, abstracted data, and resolved disagreements by consensus. Only prospective observational cohorts or clinical trials of adults were assessed for quality.
 
Results
Delirious patients had significantly higher mortality during (overall risk ratio 2.55, 82.67% confidence interval 1.94 to 3.35; P<0.001). Patients with delirium also reported longer hospital LOS and ICU LOS. The overall hospital LOS standard mean difference for overall studies is 1.07, 97.85% confidence interval 0.70 to 1.43; P<0.001. The overall ICU LOS mean difference is 4.93, 98.3% confidence interval 3.98 to 5.88; P<0.001. As per this updated review and meta-analysis, there is an association between delirium and ICU LOS and hospital LOS which ultimately leads to increase in cost. The cost analysis of recent studies showed that the cost of ICU stay is 40.8% and hospital stay is 41.4% more in delirious patients. Sensitivity analysis looking at recent studies and high quality papers, showed consistent results.
 
Conclusions
Delirium results in increased risk of mortality, long length of stays in hospital and long length of stays in ICUs. In delirium patients, the mortality rate, hospital LOS, and ICU LOS are associated with an increase in cost.






 
 


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