ICU Delirium: a One-week Snapshot of Burden Across the Eastern UK Region

Study Overview
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Brief Summary
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ICU delirium negatively impacts on patient outcomes, as well as on resources and clinical workflow of the ICU. Effective healthcare resource planning requires reliable (i.e., multicentre) data that can inform on both of these. The purpose of this study was to determine the impact of ICU delirium in terms of both patients and beds. The study was carried out prospectively, over a one-week period, at adult ICUs comprising the Norfolk, Suffolk, and Cambridgeshire Critical Care Network (NSC CCN).

Detailed Description
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Previous delirium prevalence research has been carried out at single sites and yielded highly variable results (between 3-87%). Reliable multisite data can be obtained cost-effectively using a point-prevalence (snapshot) approach. Purpose: to obtain reliable data informing on prevalence of ICU delirium, in terms of both patients and beds, across the eastern UK region. Design and Setting: this one-week observational prospective cohort study was carried out between June 25, 2012 (start of ICU day shift) to July 01, 2012 (end of night shift). Nine ICUs comprising the Norfolk, Suffolk, and Cambridgeshire Critical Care Network (NSC CCN) took part. Cambridgeshire 2 Research Ethics Committee approved the study (REC reference: 10/H0308/116) and waived the need for informed consent. Patients and procedure: All adults treated over the study week at participating ICUs were considered eligible for inclusion. Delirium screening was carried out by patients' direct care clinicians using the Confusion Assessment Method for the ICU (CAM-ICU). All sites used this tool as part of their routine clinical practice and had delirium management guidelines in place at the time of the study. Patients who screened positive for delirium were treated according to local hospital practice.

Official Title
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ICU Delirium: a One-week Snapshot of Burden Across the Eastern UK Region

Conditions
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Delirium

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients treated within study time frame on Intensive Care Units across Norfolk, Suffolk, and Cambridgshire, UK Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Adult critically ill patients<br>All adult patients treated within study time frame on Intensive Care Units across Norfolk, Suffolk, and Cambridgshire, UK | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delirium prevalence | Number of patients with at least one recorded delirium-positive result, over total number of patients recorded over study time frame. Delirium screening will be carried out using the CAM-ICU by local direct care clinicians in accordance with region-wide clinical delirium-screening guidelines. | June 25, 2012 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patient-days with delirium | Number of patient-days with at least one recorded delirium-positive result over total patient-days recorded. | June 25, 2012 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Median delirium duration | In delirium patients: median number of days recorded with delirium over study time frame. | June 25, 2012 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Median days to transition to delirium | In delirium patients admitted during study time frame: median number of days from ICU admission to first recorded delirium day. | June 25, 2012 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Patient age, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: median age. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Patient gender, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: number of males over total patients in each group. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Admission type, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: number of (1) urgent/emergency and (2) elective admissions, over total patients in each group. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Admission reason, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: number of (1) medical and (2) surgical admissions, over total patients in each group. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Organ support, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: number receiving advanced and basic respiratory, advanced and basic cardiovascular, and renal support since ICU admission to end of study time frame, over total patients in each group. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Mobilisation therapy, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: number receiving mobilisation therapy over study time frame, over total patients in each group. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Median ICU days, by delirium status | In delirium patients versus patients with no recorded delirium-positive result over study time frame: median number of patient-days in ICU per patient, since admission to end of study time frame. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 
| Delirium screening compliance | Number of patient-days CAM-ICU administered (1) once or more and (2) twice or more, over total number of patient-days recorded over study time frame. | June 25 (start of ICU day shift) to July 1, 2012 (end of ICU night shift) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Delirium, Intensive Care Unit, Critical illness