ABSTRACT
Background: Subsyndromal delirium [SSD] is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit [ICU] remains unclear
Aim of the study: To evaluate the significance of SSD on adverse clinical outcomes especially mortality and length of hospital stay
Methods: A systematic search was performed in the scientific database particularly MEDLINE [2000-2017], EMBASE [2000- 2017], Cochrane Central Register of Controlled Trials, CINAHL [2000-2017], Google Scholar, and individual journals to identify publications that evaluated SSD in ICU patients
Results: The search yielded five studies involving 2453 patients. SSD was detected in 849 patients [34.6%]. Three studies evaluated only surgical patients. Three studies used the Intensive Care Delirium Screening Checklist [ICDSC] and two used the Confusion Assessment Method [CAM] score to diagnose SSD. The meta-analysis showed an increased hospital length of stay [LOS] in SSD patients [0.29 [95% CI 0.11-0.48], p = 0.002; I [2] = 33%]. Hospital mortality was described in two studies but it was not significant [hazard ratio 0.93 [0.58-1.43], p = 0.88 and [4 [1.0-6.9] vs 9 [3.6-20.4], p = 0.05]. The use of antipsychotics in SSD patients to prevent delirium was evaluated in one study but it did not modify ICU LOS [6.2 [4-8] vs 7 [4-9] days, p = 0.63 and 2 [2-3] vs 3 [2-3] days, p = 0.517] or mortality [9 [25.8%] vs 7 [20.4%], p = 0.51]
Conclusion: Subsyndromal Delirium is a common and adverse condition that is manifested in almost one-third of ICU patients. According to our findings, SSD has increased the length of hospital stay only with low impact on the other outcomes. Nevertheless, studies on a bigger sample size and larger scale are needed for a better understanding of the relevance of SSD in ICU patients as well as its treatment
ABSTRACT
Purpose: The Purpose of this study is to detect differences between the values of dynamic coracohumeral distance [CHD] measured using ultrasonography [USG] in different shoulder rotations and to investigate its correlation with subscapularis tear
Methods:We prospectively enrolled consecutive patients [n = 84] who were scheduled to have arthroscopic rotator cuff repair. Patients with a history of previous shoulder surgery or shoulder fracture and patients with external rotation less than 30 were excluded from the study. Dynamic coracohumeral distance was measured utilizing ultrasonography in 3 different shoulder positions: external rotation, neutral and internal rotation. We assessed the intrarater reliability with 3 times repetition of measurement. Patients were divided into one of 3 groups according to arthroscopic findings: intact subscapularis, partial-thickness tear, and full-thickness tear of the subscapularis. The control group [n = 12] included patients without rotator cuff tears from the outpatient clinic. Subgroup analysis according to the presence of dynamic subcoracoid stenosis, defined as a coracohumeral distance less than 6 mm measured in internal rotation was performed to find the clinical effect of dynamic subcoracoid stenosis
Results: A partial-thickness tear of the subscapularis tendon was present in 30 patients [35.7%] and a full-thickness tear in 13 patients [15.5%] among 84 patients. The CHD was maximum in external rotation and the narrowest in internal rotation. There were no statistical differences in the CHDs between groups with different subscapularis tear status. According to the presence of dynamic subcoracoid stenosis, patients with dynamic subcoracoid stenosis had a significantly higher incidence of partial-thickness subscapularis tear than those without stenosis [P = 0.018]
Conclusions: The coracohumeral distance values were narrowest in shoulder internal rotation, which is thought to be the pathogenic position. We could not confirm the correlation between coracohumeral distance and subscapularis tear. However, patients who have dynamic subcoracoid stenosis had significantly higher incidence of subscapularis tear than others without dynamic stenosis