Journal article
Delirium at the end of life.
- Knoepfel S Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- Bode L Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- Gehrke S Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- Spiller T Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- Fuchs S Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- Ernst J Center of Clinical Nursing Science, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- von Känel R Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- Boettger S Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
- 2020-09-10
Published in:
- Palliative & supportive care. - 2020
Delirium at the end of life
In-hospital mortality
Interrelationship of delirium and death
Terminal delirium
English
BACKGROUND
The general in-hospital mortality and interrelationship with delirium are vastly understudied. Therefore, this study aimed to assess the rates of in-hospital mortality and terminal delirium.
METHOD
In this prospective cohort study of 28,860 patients from 37 services including 718 in-hospital deaths, mortality rates and prevalence of terminal delirium were determined with simple logistic regressions and their respective odds ratios (ORs).
RESULTS
Although overall in-hospital mortality was low (2.5%), substantial variance between services became apparent: Across intensive care services the rate was 10.8% with a 5.8-fold increased risk, across medical services rates were 4.4% and 2.4-fold, whereas at the opposite end, across surgical services rates were 0.7% and 87% reduction, respectively. The highest in-hospital mortality rate occurred on the palliative care services (27.3%, OR 19.45). The general prevalence of terminal delirium was 90.7% and ranged from 83.2% to 100%. Only across intensive care services (98.1%, OR 7.48), specifically medical intensive care (98.1%, OR 7.48) and regular medical services (95.8%, OR 4.12) rates of terminal delirium were increased. In contrast, across medical services (86.4%, OR 0.32) and in particular oncology (73.9%, OR 0.25), pulmonology (72%, OR 0.31) and cardiology (63.2%, OR 0.4) rates were decreased. For the remaining services, rates of terminal delirium were the same.
SIGNIFICANCE OF RESULTS
Although in-hospital mortality was low, the interrelationship with delirium was vast: most patients were delirious at the end of life. The implications of terminal delirium merit further studies.
The general in-hospital mortality and interrelationship with delirium are vastly understudied. Therefore, this study aimed to assess the rates of in-hospital mortality and terminal delirium.
METHOD
In this prospective cohort study of 28,860 patients from 37 services including 718 in-hospital deaths, mortality rates and prevalence of terminal delirium were determined with simple logistic regressions and their respective odds ratios (ORs).
RESULTS
Although overall in-hospital mortality was low (2.5%), substantial variance between services became apparent: Across intensive care services the rate was 10.8% with a 5.8-fold increased risk, across medical services rates were 4.4% and 2.4-fold, whereas at the opposite end, across surgical services rates were 0.7% and 87% reduction, respectively. The highest in-hospital mortality rate occurred on the palliative care services (27.3%, OR 19.45). The general prevalence of terminal delirium was 90.7% and ranged from 83.2% to 100%. Only across intensive care services (98.1%, OR 7.48), specifically medical intensive care (98.1%, OR 7.48) and regular medical services (95.8%, OR 4.12) rates of terminal delirium were increased. In contrast, across medical services (86.4%, OR 0.32) and in particular oncology (73.9%, OR 0.25), pulmonology (72%, OR 0.31) and cardiology (63.2%, OR 0.4) rates were decreased. For the remaining services, rates of terminal delirium were the same.
SIGNIFICANCE OF RESULTS
Although in-hospital mortality was low, the interrelationship with delirium was vast: most patients were delirious at the end of life. The implications of terminal delirium merit further studies.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1017/S1478951520000875
- PMID 32909932
- Persistent URL
- https://sonar.ch/global/documents/260881
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