Antipsychotic use and diagnosis of delirium in the intensive care unit.
Crit Care. 2012 May 16;16(3):R84
Authors: Swan JT, Fitousis K, Hall JB, Todd SR, Turner KL
ABSTRACT: INTRODUCTION: Delirium is an independent risk factor for prolonged hospital length of stay (LOS) and increased mortality. Several antipsychotics have been studied for the treatment of intensive care unit (ICU) delirium that has lead to a high variability in prescribing patterns for these medications. We hypothesize that in clinical practice the documentation of delirium is lower than the incidence of delirium reported in prospective clinical trials. The objective of this study was to document the incidence of delirium diagnosed in ICU patients and to describe the utilization of antipsychotics in the ICU. METHODS: Retrospective observational cohort study conducted at seventy-one United States academic medical centers that reported data to the University HealthSystem Consortium Clinical Database/Resource Manager. Included all patients 18 years of age and older admitted to the hospital between January 1, 2010 and June 30, 2010 with at least one day in the ICU. RESULTS: Delirium was diagnosed in 6% (10,034 of 164,996) of hospitalizations with an ICU admission. Antipsychotics were administered to 11% (17,764 of 164,996) of patients. Of the antipsychotics studied, the most frequently used were haloperidol (62%; n=10,958) and quetiapine (31%; n=5,448). Delirium was associated with increased ICU LOS (5 vs. 3 days, P<0.001) and hospital LOS (11 vs. 6 days, P<0.001), but not in-hospital mortality (8% vs. 9%, P=0.419). Antipsychotic exposure was associated with increased ICU LOS (8 vs. 3 days, P<0.001), hospital LOS (14 vs. 5 days, P<0.001) and mortality (12% vs. 8%, P<0.001). Of patients with antipsychotic exposure in the ICU, absence of a documented mental disorder (32%, n=5,760) was associated with increased ICU LOS (9 vs. 7 days, P<0.001), hospital LOS (16 vs. 13 days, P<0.001) and in-hospital mortality (19% vs. 9%, P<0.001) compared to patients with a documented mental disorder (68%, n=12,004). CONCLUSIONS: The incidence of documented delirium in ICU patients is lower than that documented in previous prospective studies with active screening. Antipsychotics are administered to one in every ten ICU patients. When administration occurs in the absence of a documented mental disorder, antipsychotic use is associated with an even higher ICU and hospital LOS, as well as in-hospital mortality.
PMID: 22591601 [PubMed - as supplied by publisher]