Impact of Family Presence on Delirium in Critically Ill Patients: A Retrospective Cohort Study
patient and family-centered care
retrospective cohort study
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AbstractDelirium, an acutely disturbed state of consciousness, manifests as a collection of symptoms such as confusion. There is potential for family members of critically ill patients to assist in non-pharmacological delirium prevention and management (e.g., re-orientation). Despite this, there are few studies on the impact of Intensive Care Unit (ICU) family presence on delirium. To bridge these knowledge gaps, our study employed a population-based retrospective cohort design to explore the association between family presence and both the incidence and duration of delirium in critically ill patients. The electronic health records of consecutive adult patients admitted to any of 14 adult medical-surgical adult ICUs in Alberta, Canada between January 1, 2014 and December 30, 2018 were examined. Family presence in the ICU (exposure), was extracted using a validated algorithm (1. family physically present, 2. family phone call only, 3. no family presence or call [reference group]). Delirium was measured using the Intensive Care Delirium Screening Checklist (ICDSC). Incident delirium was quantified (primary outcome) using an ICDSC cut-off of ≥4 points, after family presence (yes/no). Duration of delirium (secondary outcome) was measured as the total number of ICU days (24-hour periods) with a positive ICDSC score (≥4 points). Multivariable mixed-effects logistic and linear regression models (accounting for clustering by patient re-admission and ICU site, where appropriate) were used to evaluate the association between family member presence and the incidence and duration of delirium in critically-ill patients in the ICU, respectively. All regression models were adjusted for relevant covariates (e.g., ICU admission type, Glasgow Coma Scale [GCS]). We included 25,537 patients. Family presence in the ICU was associated with lower incidence of delirium during elective-surgical admissions in patients with intact GCS (OR 0.60, 95%CI:0.39-0.97, p=0.02) as compared to patients in the reference group. Family presence in the ICU decreased duration of delirium (adjusted mean difference -1.87 days, 95%CI: -2.01 to -1.81, p<0.001) as compared to patients in the reference group. Family presence in the ICU may decrease the incidence of delirium in patients admitted for elective-surgical reasons with intact GCS and duration of delirium in all patients by up to 2 days.
CitationMohsen, S. T. (2021). Impact of Family Presence on Delirium in Critically Ill Patients: A Retrospective Cohort Study (Unpublished master's thesis). University of Calgary, Calgary, AB.
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