Abstract
Background: To address whether in intensive care unit (ICU) patients, which factors correlate with development of delirium (primary outcome), as well as more rapid delirium onset and recurrence (secondary outcomes).Methods: A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors.Results: Increased delirium risk as associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95% CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95% CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95% CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95% CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95% CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95% CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95% CI: 0.456-0.567, P<0.001). CHAID modelling indicated that AL exposure and age <65 years conveyed a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex were associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age>65 years (HR 2.198; %95 CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95% CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables.Conclusion: Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements.
Combinations of Drinking Occasion Characteristics Associated with Units of Alcohol Consumed among British Adults: An Event‐Level Decision Tree Modeling Study
