Incidence, Severity and Treatment of Delirium in Cardiac Surgery Patients: A Before-after Study

Study Overview
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Brief Summary
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Delirium is a common yet under diagnosed condition in hospitalized patients, and the incidence have not previously been described in Danish cardiac surgery patients. The present study seeks to describe the incidence and duration of delirium in this group of patients, before and after the introduction of standardized screening tool and a guideline for treatment of delirium after cardiac surgery.

Detailed Description
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Delirium is a common yet under diagnosed condition in cardiac surgery patients, and may cause prolonged cognitive impairment and increased risk of complications. Patients are at risk of e.g. pulling catheters and lines and may fall attempting to get out of bed. The aging patient population present with many risk factors for developing delirium, but diagnostic tools have been few. Almost 50% present with hypoactive delirium, which is often not diagnosed, nor treated correctly. To optimize effect, treatment should be initiated early, maintained until clinical improvement is observed, and then tapered gradually. Recently, Delirium Observation Screening scale (DOS scale) was developed and validated in elective cardiac surgery patients in the Netherlands, with interesting results. This encouraged us to evaluate the effects of systematic delirium screening and treatment in cardiac surgery patients. To our knowledge, no prior studies have evaluated use of DOS scale in this context. OBJECTIVES To evaluate the incidence and severity of delirium, and the effects of standardized treatment in a population of Danish cardiac surgery patients.

Official Title
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Incidence, Severity and Treatment of Delirium in Cardiac Surgery Patients: A Before-after Study

Conditions
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Delirium

Intervention / Treatment
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* Other: systematic screening and treatment of delirium


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patients admitted for cardiac surgery at department of cardiothoracic surgery, Rigshospitalet, denmark Exclusion Criteria: patients under age 18, patients that died within 24 hours after admission.

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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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: before<br>no systematic approach | |
| Experimental: after<br>systematic screening and treatment of delirium | Other: systematic screening and treatment of delirium<br>* systematic screening for delirium with DOS scale and CAM ICU. In case of delirium, treatment according to guidelines.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of delirium free days | number of delirium free days are calculated as percentage of length of stay (LOS) in days. Participants will be followed for the duration of hospital stay, an expected average of 2 weeks | 14 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| complication rates | complications: respiratory, re-operation, infection, acute kidney injury (AKI), cerebral, cardiac, bleeding. participants will be followed for the duration of hospital stay, an expected average of 2 weeks | 14 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Delirium, Cardiac surgery, DOS scale