4.5 Article

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

Journal

BMC PSYCHIATRY
Volume 22, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12888-022-03809-2

Keywords

Delirium; Encephalopathy; COVID-19; Hospitalization; Restraints; Safety attendants; Hospital discharge; Patient outcomes

Categories

Funding

  1. National Institute on Aging [R03AG074035, 5R01AG056715, R01 AG068025]
  2. Larry L. Hillblom Foundation [A137420]
  3. Bakar Aging Research Institute
  4. National Institute of Neurological Disorders and Stroke [1K23NS116128-01]
  5. American Academy of Neurology
  6. Sara & Evan Williams Foundation Endowed Neurohospitalist Chair
  7. UCSF Claude D. Pepper Older Americans Independence Center - National Institute on Aging [P30 AG044281]
  8. National Institute on Aging Mentored Research Scientist Development Award [K01 AG059831]

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This study aimed to investigate the association between COVID-19 severity on hospital admission and delirium in hospitalized patients. Results showed that patients with more severe disease on admission and older age were more likely to experience delirium. Patients with delirium were more likely to require safety attendants, had longer hospital stays, and were less likely to be discharged home.
Background Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay. Methods In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols. Results A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008). Conclusions While delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.

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