Application of graded nursing intervention based on the early delirium prediction model to prevent delirium in ICU patients / 中国实用护理杂志

Objective@#To study the application effect of graded nursing intervention for ICU patients combined with the Pre-Deliric prediction model.@*Methods@#A total of 288 ICU patients were elected and divided into the control group (141 cases from May 2017 to October 2017) and the intervention group (147 cases from November 2017 to April 2018) according to hospitalization time. The control group received conventional delirium prevention measures. The intervention group was assessed within 24 h following admission with Pre-Deliric prediction model to screen the risk of delirium, and then they received grading prevention care based on the assessment results of delirium risks. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU. The incidence and duration of delirium, 28d survival rate, ICU length of stay of the two groups were statistically analyzed.@*Results@#Compared with the control group, we detected that the incidence of delirium in the intervention group was significantly lower (χ2=5.043, P<0.05), 21.7%(32/147) vs. 35.5%(50/141). Compared with the control group, we found that the duration of delirium in the intervention group was significantly shorter,(1.68±1.24) vs.(2.82±1.60)d, the ICU length of stay in the intervention group were significantly shorter than the control group(t=4.45, P<0.01), (3.42±3.02)d vs (6.21±4.56)d. There was no significant difference in the 28-day ICU survival rate between the two groups (P>0.05).@*Conclusions@#the risk assessment and grading nursing care combined with Pre-Deliric prediction model could effectively prevent the occurrence and shorten the duration of delirium, and also shorten the ICU length of stay.It was significant for improve the quality of nursing.

Application of graded nursing intervention based on the early delirium prediction model to prevent delirium in ICU patients / 中国实用护理杂志

Objective To study the application effect of graded nursing intervention for ICU patients combined with the Pre-Deliric prediction model. Methods A total of 288 ICU patients were elected and divided into the control group (141 cases from May 2017 to October 2017) and the intervention group (147 cases from November 2017 to April 2018) according to hospitalization time. The control group received conventional delirium prevention measures. The intervention group was assessed within 24 h following admission with Pre-Deliric prediction model to screen the risk of delirium, and then they received grading prevention care based on the assessment results of delirium risks. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU. The incidence and duration of delirium, 28d survival rate, ICU length of stay of the two groups were statistically analyzed. Results Compared with the control group, we detected that the incidence of delirium in the intervention group was significantly lower (χ2=5.043, P<0.05), 21.7%(32/147) vs. 35.5%(50/141). Compared with the control group, we found that the duration of delirium in the intervention group was significantly shorter,(1.68 ± 1.24) vs.( 2.82 ± 1.60)d, the ICU length of stay in the intervention group were significantly shorter than the control group(t=4.45﹐P<0.01), (3.42±3.02)d vs (6.21± 4.56)d. There was no significant difference in the 28-day ICU survival rate between the two groups (P>0.05). Conclusions the risk assessment and grading nursing care combined with Pre-Deliric prediction model could effectively prevent the occurrence and shorten the duration of delirium, and also shorten the ICU length of stay. It was significant for improve the quality of nursing.

Avaliação de delirium com uso do modelo PRE-DELIRIC em uma unidade de terapia intensiva na Argentina / Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

RESUMO Objetivo: Descrever a incidência e os fatores de risco para delirium na unidade de terapia intensiva de um hospital terciário de ensino na Argentina, e conduzir o primeiro estudo não europeu para explorar o desempenho do modelo PREdiction of DELIRium in ICu Patients (PRE-DELIRIC). Métodos: Estudo prospectivo observacional em uma unidade de terapia intensiva com 20 leitos localizada em um hospital terciário de ensino em Buenos Aires, Argentina. O modelo PRE-DELIRIC foi aplicado a 178 pacientes consecutivos dentro de 24 horas após sua admissão à unidade de terapia intensiva. Avaliou-se o delirium com uso da ferramenta Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Resultados: A média de idade foi de 64,3 ± 17,9 anos. O tempo mediano de permanência na unidade de terapia intensiva foi de 6 dias (variação entre 2 e 56 dias). Dentre o total de pacientes, 49/178 (27,5%) desenvolveram delirium, definido como avaliação positiva segundo a CAM-ICU, durante a permanência na unidade de terapia intensiva. Os pacientes no grupo com delirium eram significantemente mais velhos e tinham escore Acute Physiological and Chronic Health Evaluation II (APACHE II) significantemente mais elevado. A taxa de mortalidade na unidade de terapia intensiva foi de 14,6%; não se observou diferença significante entre os dois grupos. Os fatores preditivos para desenvolvimento de delirium foram idade mais avançada, tempo prolongado de permanência na unidade e uso de opioides. A área sob a curva para o modelo PRE-DELIRIC foi de 0,83 (IC95%: 0,77 - 0,90). Conclusões: A incidência observada de delirium salienta a importância deste problema no ambiente da unidade de terapia intensiva. Neste primeiro estudo conduzido fora da Europa, o PRE-DELIRIC previu de forma precisa o desenvolvimento de delirium.

ABSTRACT Objective: To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model. Methods: Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Results: The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90). Conclusions: The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.

Comparison of PRE-DELIRIC and E-PRE-DELIRIC delirium prediction models in ICU patients / 中国实用护理杂志

Objective To assess and compare the predicted abilities of PRE- DELIRIC and E-PRE-DELIRIC two delirium prediction models in ICU patients. Methods From January 2017 to April 2017, 265 critically ill patients who met the inclusion criteria were included in this study. The clinical data of all the included patients, respectively calculated the scores with both PRE-DELIRIC and E-PRE-DELIRIC rating software were collected. Forecasting performance of two different models of discrimination and calibration were assessed. 2 medical staff assessed 20 patients with the Chinese version PRE-DELIRIC and E-PRE-DELIRIC,while the intraclass correlation coefficients were accumulated to evaluate the inter-rater reliability. Results The average scores of PRE-DELIRIC were46.41 ± 14.05in delirium group and20.08 ± 9.96 in patients without delirium, the difference between scores was statistically significant (t=14.34, P<0.05). The average scores of E-PRE-DELIRIC were36.23±13.34in delirium group and14.45±9.56 in patients without delirium, the difference between scores was statistically significant (t=14.59, P<0.05). The AUROCC and its 95％CI of the PRE-DELIRIC and E-PRE-DELIRIC for prediction of delirium were 0.928(0.891-0.965) and 0.904(0.861-0.947) respectively in all patients. Discrimination was generally good for two models. The PRE-DELIRIC and E-PRE-DELIRIC sensitivity were 0.841, 0.812, specificity was 0.939, 0.913, the threshold values of PRE-DELIRIC model was 36.5％and E-PRE-DELIRIC model was 30.5％. The Youden′s index of PRE–DELIRIC model was 0.779, which better than 0.725 of E-PRE-PREDIRIC model. Conclusions The PRE-DELIRIC and E-PRE-DELIRIC models both have high accuracy in predicting delirium of patients in intensive care unit. PRE-DELIRIC does better performance than E-PRE-DELIRIC, but has imitation in terms of time. E-PRE-DELIRIC model can be used in ICU patients who develop delirium within 24 h following admission.