Antipsychotic use and diagnosis of delirium in the intensive care unit

Swan JT et al. – The incidence of documented delirium in intensive care unit (ICU) patients is lower than that documented in previous prospective studies with active screening. Antipsychotics are administered to one in every ten ICU patients. When administration occurs in the absence of a documented mental disorder, antipsychotic use is associated with an even higher ICU and hospital length of stay, as well as in–hospital mortality.

Methods

• Retrospective observational cohort study conducted at seventy-one United States academic medical centers that reported data to the University HealthSystem Consortium Clinical Database/Resource Manager.
• Included all patients 18 years of age and older admitted to the hospital between January 1, 2010 and June 30, 2010 with at least one day in the ICU.

Results

• Delirium was diagnosed in 6% (10,034 of 164,996) of hospitalizations with an ICU admission.
• Antipsychotics were administered to 11% (17,764 of 164,996) of patients.
• Of the antipsychotics studied, the most frequently used were haloperidol (62%; n=10,958) and quetiapine (31%; n=5,448).
• Delirium was associated with increased ICU LOS (5 vs. 3 days, P<0.001) and hospital LOS (11 vs. 6 days, P<0.001), but not in-hospital mortality (8% vs. 9%, P=0.419).
• Antipsychotic exposure was associated with increased ICU LOS (8 vs. 3 days, P<0.001), hospital LOS (14 vs. 5 days, P<0.001) and mortality (12% vs. 8%, P<0.001).
• Of patients with antipsychotic exposure in the ICU, absence of a documented mental disorder (32%, n=5,760) was associated with increased ICU LOS (9 vs. 7 days, P<0.001), hospital LOS (16 vs. 13 days, P<0.001) and in-hospital mortality (19% vs. 9%, P<0.001) compared to patients with a documented mental disorder (68%, n=12,004).

[more...]