ABSTRACT
Aim: While recent evidence describes atypical outcomes of coronavirus disease 2019 (COVID-19) in elderly patients, the frequency of delirium and associated outcomes in elderly patients with COVID-19 (coronavirus disease 2019) infection undergoing emergency surgery are not well defined. This study aims to determine the effect of COVID-19 on postoperative delirium and postoperative death in elderly patients undergoing emergency surgery. Material(s) and Method(s): This descriptive and cross-sectional study was conducted in general surgery, orthopedics, and cardiovascular surgery clinics of a public hospital, including 30 days of follow-up between April 1 and May 1, 2021. All patients who were admitted to these clinics for emergency surgery intervention on these dates constituted the study population, while a total of 140 patients aged >=65 years, who met the study criteria, formed the sample of the study. Descriptive Characteristics Form and Nursing Delirium Screening Scale (Nu-DESC) were used as data collection tools in the study. SPSS 25.0 statistical program was used for data analysis. Result(s): Thirty (42.85%) of the SARS-CoV-2 positive (n=70) patients developed delirium in the study. 12.9% (n=18) of the patients died within 30 days of follow-up after surgery. There were 30 (69.8) of 70 SARS-CoV-2 positive patients who developed delirium, and 12 patients (25.5) died after testing positive for COVID-19, with a mean of 8.08T1.56 days within 30 days of admission. Discussion(s): These findings may lead to a poor clinical prognosis for COVID-19 infection delirium and postoperative death in patients over 65 years of age undergoing emergency surgery.Copyright © 2023, Derman Medical Publishing. All rights reserved.
ABSTRACT
BACKGROUND: In studies of COVID-19 patients, delirium is associated with functional impairments, increased length of stay (LOS), and mortality, though the condition is often under-detected. To date, no research has examined the impact of COVID-19 on the likelihood of developing delirium while hospitalized. Using a validated delirium screening tool, we examined 1) the association between COVID-19 diagnosis and incidence of delirium among patients admitted to acute care units at a large, urban academic hospital, and 2) factors associated with the incidence of delirium among patients admitted with COVID-19. METHODS: The study population consists of all adult patients admitted to acute care units at Froedtert & the Medical College of Wisconsin from July 2020 to February 2021. Patients were excluded if they had delirium at admission, were admitted from an ICU, or had history of a psychiatric diagnosis. Delirium was assessed using Nursing Delirium Screening Scale (NuDESC). Screening occurred every 8 hours;patients scoring ≥ 2 were considered delirious. COVID-positivity was assessed via Polymerase Chain Reaction (PCR) test prior to admission or after admission but prior to delirium onset. A multivariate logistic regression was used to estimate the association between COVID-19 status and odds of developing deliriumduring the hospital stay, adjusting for demographics, financial vulnerability (uninsured or Medicaid enrollees), comorbidities, and time fixed effects. RESULTS: 20,509 patients were included. The mean age was 55.6 (SD=19.7), with 9,768 (47.6%) >60. 11,553 (56.3%) were female. 4,351 (21.2%) were considered financially vulnerable. 374 patients (1.8%) tested positive for COVID-19. 2,278 patients (11.1%) developed delirium. Of COVID-positive patients, the incidence rate of developing delirium rose to 18.2%.On average, COVID-positive patients had 62%higher relative risk (OR 1.62, 95% CI 1.24-2.14, p=.001) of developing delirium than COVID-negative patients. This result persisted in sensitivity analyses where we also controlled for patients' LOS. Development of delirium was associated with male sex (OR 1.30, 95%CI 1.18-1.42, p=.000), Black race (OR 1.62, 95%CI 1.18-1.42, p=.000), Hispanic ethnicity (OR 1.33, 95%CI 1.05-1.69, p=.017), financial vulnerability (OR 1.63, 95%CI 1.42-1.89, p=.000), and age >40. Among COVID-positive patients, development of delirium was associated with male sex (OR 2.39, 95%CI 1.41-4.06, p=.000), and age >60. We found no evidence that the presence of specific COVID-19 symptom(s) increased the odds of developing delirium compared to asymptomatic COVID-19-positive patients. CONCLUSIONS: Patients with COVID-19 were significantly more likely to develop delirium during their hospital stay than their COVID-19 negative counterparts, even after controlling for confounding. Among COVID-19 positive patients, patients >60 are especially vulnerable. Providers should proactively assess delirium among COVID-19 patients, with a particular focus on the elderly.
ABSTRACT
INTRODUCTION: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. METHODS: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. RESULTS: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. CONCLUSION: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation.