Pipeline volumetric defect assessment method based on multi risk factors and in-line inspection data

Abstract Introduction Paediatric Delirium (PD) is a neuropsychiatric complication that occurs during the management of children in the critical care environment (Paediatric Intensive Care (PICU) and Neonatal Intensive Care (NICU). Delirium can be classified as hypoactive (decreased responsiveness and withdrawal), hyperactive (agitation and restlessness), and mixed (combined) (1). PD can be assessed using a number of assessment tools. PD has been historically underdiagnosed or misdiagnosed, having many overlapping symptoms with other syndrome such as pain and iatrogenic withdrawal syndrome (2). An appreciation of the extent of PD would help clinicians and policy makers drive interventions to improve recognition, prevention and management of PD in clinical practice. Aim To estimate the pooled prevalence of PD using validated assessment tools, and to identify risk factors including patient-related, critical-care related and pharmacological factors. Methods A systematic search of PubMed, EMBASE and CINAHL databases was undertaken. Eligible articles included observational studies or trials that estimated a prevalence of PD in a NICU/PICU population using a validated PD assessment tool. Validated tools are the paediatric Confusion Assessment Method-ICU (pCAM-ICU), the Cornell Assessment of Pediatric Delirium (CAPD), the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), pCAM-ICU severity scale (sspCAM-ICU), and the Sophia Observation Withdrawal Symptoms scale Paediatric Delirium scale (SOS-PD) (1). Only full text studies were included. No language restrictions were applied. Two reviewers independently screened records. Data was extracted using a pre-piloted form and independently verified by another reviewer. Quality was assessed using tools from the National Institutes of Health. A pooled prevalence was calculated from the studies that estimated PD prevalence using the most commonly applied tool, the CAPD (1). Results Data from 23 observational studies describing prevalence and risk factors for PD in critically ill children were included (Figure 1). Variability in study design and outcome reporting was found. Study quality was generally good. Using the validated tools prevalence ranged from 10–66% of patients. Hypoactive delirium was the most prevalent sub-class identified. Using the 13 studies that used the CAPD tool, a pooled prevalence of 35% (27%-43% 95%CI) was calculated. Younger ages, particularly less than two years old, sicker patients, particularly those undergoing mechanical and respiratory ventilatory support were more at risk for PD. Restraints, the number of sedative medications, including the cumulative use of benzodiazepines and opioids were identified as risk factors for the development of PD. PD was associated with longer durations of mechanical ventilation, longer stays and increased costs. Data on association with increased mortality risk is limited and conflicting. Conclusion PD affects one third of critical care admissions and is resource intense. Routine assessment in clinical practice may facilitate earlier detection and management strategies. Modifiable risk factors such as the class and number of sedative and analgesic medications used may contribute to the development of PD. Early mobility and lessening use of these medications present strategies to prevent PD occurrence. Longitudinal prospective multi-institutional studies to further investigate the presentations of the different delirium subtypes and modifiable risk factors that potentially contribute to the development of PD, are required. References 1. Semple D (2020) A systematic review and pooled prevalence of PD, including identification of the risk factors for the development of delirium in critically ill children. doi: 10.17605/OSF.IO/5KFZ8 2. Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU. Australian Critical Care. 2018;31(5):266–73

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Prevalence and risk factors of delirium and subsyndromal delirium in older adults

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-021-00042-3 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Maha Hosam El-Din Ibrahim ◽

Manal Elmasry ◽

Fady Nagy ◽

Ahmed Abdelghani

Keyword(s):

Risk Factors ◽

Older Adults ◽

Functional Ability ◽

Cognitive Assessment ◽

Length Of Hospital Stay ◽

Assessment Method ◽

Assessment Tools ◽

Subsyndromal Delirium ◽

Confusion Assessment ◽

Definition Of

Abstract Background Delirium is a common geriatric problem associated with poor outcomes. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium yet, not satisfying the definition of full-blown delirium, defined by categorical elements, and is usually referred to as the presence of one or more symptoms in the confusion assessment method (CAM). This study aimed to investigate the prevalence and risk factors of delirium and SSD in older adults admitted to the hospital. Five hundred eighty-eight elderly (above 65 years) Egyptian patients were recruited from January 2019 to February 2020. After explaining the purpose of the study and assuring the confidentiality of all participants, an informed consent was obtained from the participant or a responsible care giver for those who were not able to give consent. All patients were subjected ‘on admission’ to thorough history taking, clinical examination, and comprehensive geriatric assessment including confusion assessment tools, mini-mental state examination, and functional assessment using Barthel index score. Results The current study showed that 19.6% of patients had delirium and 14.1% of patients had SSD with combined prevalence of 33.7%. Most common causes included metabolic, infection, organic brain syndrome, and dehydration. The current study reported significant proportionate relation between cognitive assessment and functional ability, so patients with a score of 23 MMSE had good functional ability, while cognitive assessment using mini-mental score shows inversed relation to delirium and SSD using CAM score. Conclusion Delirium is independently associated with adverse short-term and long-term outcomes, including an increase in mortality, length of hospital stay, discharge to an institution, and functional decline on discharge. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium, not yet satisfying the definition of full-blown delirium but it can identify patients with early cognitive and functional disabilities, and because of high prevalence of delirium and SSD. Efforts to prevent or early detection may identify patients who warrant clinical attention.

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Do we know if our Patients are Delirious?

Journal of the Intensive Care Society ◽

10.1177/175114370800900322 ◽

2008 ◽

Vol 9 (3) ◽

pp. 269-269

Author(s):

Callum Kaye

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Critically Ill Patient ◽

Confusion Assessment ◽

Surgical Icu ◽

Symptoms And Signs

Delirium in the intensive care unit (ICU) setting is a significant cause of morbidity, mortality and increases ICU, as well as hospital length of stay1,2. Furthermore, with so many of the risk factors being present in the critically ill patient in the ICU environment, it's not surprising that other studies have found that up to 80% of patients will be delirious at some point during admission3,4. We performed a small study in a Toronto Medical-Surgical ICU using the Confusion Assessment Method for the ICU (CAM-ICU)5 to determine the prevalence of delirium in this unit. We concurrently reviewed medical and nursing notes to identify documentation of symptoms and signs that could indicate possible delirium during routine clinical assessment of the patient.

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Incidence of Delirium in Critically Ill Cancer Patients

Pain Research and Management ◽

10.1155/2018/4193275 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Luis A. Sánchez-Hurtado ◽

Nancy Hernández-Sánchez ◽

Mario Del Moral-Armengol ◽

Humberto Guevara-García ◽

Francisco J. García-Guillén ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Cancer Patients ◽

Critically Ill ◽

Potential Risk ◽

Assessment Method ◽

Icu Stay ◽

Potential Risk Factors

Objective. The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods. This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient’s ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results. There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion. Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

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Postoperative Delirium after Urological Surgery: A Literature Review

Current Urology ◽

10.1159/000499280 ◽

2019 ◽

Vol 13 (3) ◽

pp. 133-140 ◽

Cited By ~ 2

Author(s):

Ioannis Leotsakos ◽

Ioannis Katafigiotis ◽

Ofer N. Gofrit ◽

Mordechai Duvdevani ◽

Dionysios Mitropoulos

Keyword(s):

Risk Factors ◽

Literature Search ◽

Postoperative Delirium ◽

Mini Mental State Examination ◽

Confusion Assessment Method ◽

Assessment Method ◽

Factors Associated ◽

Confusion Assessment ◽

Urological Surgery ◽

State Examination

Purpose: We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods: The review after a systematic literature search included 5 studies. Results: The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion: The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.

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Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

BioMed Research International ◽

10.1155/2017/3539872 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Jie Yang ◽

Yongfang Zhou ◽

Yan Kang ◽

Binbin Xu ◽

Peng Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Sofa Score ◽

Maintenance Dose ◽

Proportional Hazards ◽

Confusion Assessment Method ◽

Assessment Method ◽

Cox Proportional Hazards ◽

Older Age ◽

Independent Risk Factors

Background. Delirium is a primary adverse event in ventilated patients who receive long-term monosedative treatment. Sequential sedation may reduce these adverse effects. This study evaluated risk factors for delirium in sequential sedation patients. Methods. A total of 141 patients who underwent sequential sedation were enrolled. Delirium was diagnosed using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Univariate and multivariate Cox proportional hazards regressions were used to predict risk factors. Results. Older age (≥51) (RR = 2.432, 95% CL 1.316–4.494, p=0.005), higher SOFA score (≥14) (RR = 2.022, 95% CL 1.076–3.798, p=0.029), regular smoking (RR = 2.366, 95% CL 1.277–4.382, p=0.006), and higher maintenance dose of midazolam (RR = 1.052, 95% CL 1.000–1.107, p=0.049) and fentanyl (RR = 1.045, 95% CL 1.019–1.072, p=0.001) when patients met sequential criteria, were independent risk factors of delirium. Sequential sedation with dexmedetomidine (RR = 0.448, 95% CL 0.209–0.963, p=0.040) was associated with a lower risk of delirium. Conclusions. Older age, higher SOFA score, regular smoking, and higher maintenance dose of midazolam and fentanyl when patients met sequential criteria were independent risk factors of delirium in sequential sedation patients. Sequential sedation with dexmedetomidine reduced risk of delirium.

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Prevalence and Characteristics of Pre-Operative Delirium in Hip Fracture Patients

Gerontology ◽

10.1159/000442385 ◽

2015 ◽

Vol 62 (4) ◽

pp. 396-400 ◽

Cited By ~ 7

Author(s):

Susan Freter ◽

Michael Dunbar ◽

Katalin Koller ◽

Chris MacKnight ◽

Kenneth Rockwood

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Hip Fracture ◽

Wait Time ◽

Confusion Assessment Method ◽

Assessment Method ◽

Negative Outcomes ◽

Time To Surgery ◽

Hip Fracture Surgery ◽

Post Surgery

Background: Delirium is a common complication of hip fracture and is associated with negative outcomes. Previous studies document risk factors for post-operative delirium but have frequently excluded patients with pre-operative delirium. Objective: This study endeavours to document prevalence and risk factors for pre-operative delirium in hip fracture patients and compares risk factor profiles and outcomes between pre- and post-operative delirium. Methods: 283 hip fracture patients were assessed pre-operatively with the Delirium Elderly At Risk (DEAR) instrument, Mini-Mental State Examination (MMSE), and Confusion Assessment Method (CAM). They were followed on post-operative days 1, 3, and 5 for the presence of delirium. Doses of opioids were recorded. Wait time to surgery, length of stay, and discharge site were noted. Results: Delirium was present in 57.6% patients pre-operatively and 41.7% post-surgery. Not all patients (62%) with pre-operative delirium also had post-operative delirium. There was a considerable overlap in risk factors, with some differences. Wait time to surgery, number of comorbidities, and total pre-operative opioid and lorazepam doses were associated with pre- but not post-operative delirium. Negative outcomes were more closely associated with post-operative delirium. Conclusion: Delirium is common in pre-hip fracture surgery patients, and not all patients with pre-operative delirium go on to have post-operative delirium. Risk factor profiles are not identical, raising the possibility of identifying and intervening in patients at high risk of delirium pre-operatively.

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Some Fundamental Aspects of High Temperature Defect Assessment

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.297-300.428 ◽

2005 ◽

Vol 297-300 ◽

pp. 428-434 ◽

Cited By ~ 1

Author(s):

Shan Tung Tu ◽

Fu Zhen Xuan

Keyword(s):

High Temperature ◽

Assessment Method ◽

Damage Effect ◽

Assessment Procedure ◽

Continuum Damage ◽

Creep Failure ◽

Failure Assessment Diagram ◽

Defect Assessment ◽

Failure Assessment ◽

Dependent Failure

Current research efforts in the development of high temperature defect assessment procedure are summarized. Creep exemption criteria are proposed for the assessment of defective structures at high temperature in consideration of the effects of loadings, operating temperature and service time. Time-dependent failure assessment diagram (TDFAD) is developed that covers major failure mechanisms of defective high temperature structures. Challenges due to the welding effect are discussed. TDFAD for weldments is derived for various combinations of materials. In order to develop a unified assessment method to cope with material and loading complexity, a new failure assessment diagram based on continuum damage concept is proposed to reflect the damage effect on ductile creep failure and brittle creep fracture.

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Delirium in Hospitalized Older Patients: Recognition and Risk Factors

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/089198879801100302 ◽

1998 ◽

Vol 11 (3) ◽

pp. 118-125 ◽

Cited By ~ 142

Author(s):

Sharon K. Inouye

Keyword(s):

Risk Factors ◽

High Risk ◽

Older Patients ◽

Confusion Assessment Method ◽

Assessment Method ◽

Precipitating Factors ◽

Acute Confusional State ◽

Confusional State ◽

Confusion Assessment ◽

Simplified Algorithm

Delirium, or acute confusional state, represents a common, serious, potentially preventable and increasing problem for older hospitalized patients. This study is intended to improve overall understanding of the problem of delirium and thus to lessen its adverse impact on the older population. The specific aims of this study are (1) to examine the epidemiology of delirium in older patients; (2) to evaluate barriers to recognition; (3) to present the Confusion Assessment Method (CAM) simplified algorithm to improve recognition; (4) to elucidate predisposing and precipitating factors for delirium; and (5) to propose preventive strategies. Delirium occurs in 10-60% of the older hospitalized population and is unrecognized in 32-66% of cases. The CAM algorithm provides a sensitive (94-100%), specific (90-95%), reliable, and easy to use means for identification of delirium. Four predisposing and five precipitating factors were identified and validated to identify patients at high risk for development of delirium. Primary prevention of delirium should address important delirium risk factors and target patients at intermediate to high risk for delirium at admission.

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