There are a growing number of superb web based resources available across the globe containing valuable information about Delirium (also referred to as Acute Confusional State) for clinicians, staff, patients and relatives. The websites featured opposite all offer opportunities for site visitors to download information and training materials. Click on a site to read more about each one.
The Stop Delirium resources, available to download from the European Delirium Association website were developed in conjunction with 6 care homes in Leeds
The following text on Delirium and ICU was kindly supplied by Dr Valerie Page.
Delirium
is a common, life-threatening and potentially preventable clinical
syndrome. It is the commonest neuropsychiatric condition in hospital
with a documented incidence in ventilated intensive care patients of up
to 81%. This organ dysfunction is grossly under recognized because the
majority of patients have a hypoactive or "quiet" delirium
characterised by negative symptoms of inattention and a flat affect. It
is an independent predictor of death and associated with other worse
outcomes including cognitive impairment, depression and discharge to a
nursing home. At any one time in the NHS there are around 3 500
patients in general and specialist intensive care or high dependency
units; recent UK audit data suggest that 30% to 69% of these patients
will be suffering from delirium.
Critical care patients who
experience delirium have a 29% greater chance of remaining in the ICU
and 41% chance of remaining in hospital on any given day after
adjusting for confounding factors including severity of illness. Each
additional day spent in delirium is associated with a 20% increased
risk of prolonged hospitalisation - translating to over 10 additional
days - and a 10% increased risk of death. The cost per UK intensive
care unit bed day exceeds £1330 and demand for intensive care beds
exceeds supply. Higher severity and duration of delirium is associated
with incrementally greater costs. A study from the United States
showed that delirium is associated with 39% higher ICU and 31% higher
hospital costs.
Delirium can alter the course of an underlying
dementia, with dramatic worsening of the trajectory of cognitive
decline, resulting in more rapid progress of functional losses and
worse long-term outcomes. The costs to the NHS following discharge of
patients who suffer delirium in intensive care units has not been
quantified but would be expected to be significant.
