신경계 중환자실 노인 환자의 섬망 중증도에 따른 영향 요인: 의무기록자료를 이용한 후향적 연구

Abstract

Purpose The purpose of this study was to identify predisposing, precipitating, and environmental factors related to the severity of delirium among older adults in a neurologic intensive care unit (ICU) based on the clinical practice guideline. Methods A retrospective study was conducted using electronic medical record data from 945 older adults admitted to the neurological ICU at a tertiary hospital in Seoul, South Korea from January 2020 to July 2023. Delirium and subsyndromal delirium were evaluated using the Intensive Care Delirium Screening Checklist. Statistical analyses were performed using one-way ANOVA, χ2 tests, and multinomial logistic regression using the SPSS/WIN 26.0 program. Results Compared with the normal group, a multinominal analysis revealed factors significantly associated with both delirium and subsyndromal delirium, including physical function, the length of ICU stay, dexmedetomidine use, anticonvulsants use, and physical restraints. However, compared to the normal group, ICU stay emerged as the most strongly related factor to delirium, whereas physical function was identified as the most significant factor related to subsyndromal delirium. These findings suggest that factors associated with delirium vary by its severity. Conclusion Understanding the factors associated with delirium and subsyndromal delirium is crucial for clinicians. Pre-classification of high-risk groups based on the delirium severity among critically ill older adults is essential for providing high-quality delirium prevention.