Incidence and predictors of delirium among the intensive care unit patients at Jimma Medical Center, Southwest Ethiopia

Asaminew Habtamu; Taye Mezgebu; Abdata Workina; Bulcha lemma; Feyissa Tolessa; Edmialem Getahun; Adebabay Wondimagegn; Achalu Kelbessa; Fikadu Abebe

doi:10.18502/fem.v8i4.17082

Asaminew Habtamu Department of Emergency Medicine and Critical Care Nursing, school of Nursing, institute of health science, Jimma University, Ethiopia.
Taye Mezgebu Department of Emergency Medicine and Critical Care nursing, school of Nursing, college of health science, Wachemo University, central Ethiopia
Abdata Workina Department of Emergency Medicine and Critical Care Nursing, school of Nursing, institute of health science, Jimma University, Ethiopia
Bulcha lemma School of Medicine, Medical Sciences faculty, institute of health, Jimma University, Ethiopia.
Feyissa Tolessa Department of Health policy and management, institute of health, Public Health faculty, Jimma University, Ethiopia
Edmialem Getahun Department of Emergency Medicine and Critical Care nursing, school of Nursing’s St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Adebabay Wondimagegn Department of Emergency Medicine and Critical Care nursing, Jimma Medical Center, Jimma, Ethiopia.
Achalu Kelbessa Department of Adult Health Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Fikadu Abebe Department of Reproductive Health, institute of health, Public Health faculty, Jimma University, Ethiopia.

DOI: https://doi.org/10.18502/fem.v8i4.17082

Keywords: Delirium; Incidence; Intensive Care Unit, Jimma Medical Center

Abstract

Objective: Delirium is characterized by impaired attention and awareness, accompanied by cognitive deficits. It develops rapidly and poses a considerable burden on healthcare systems. Patients in the intensive care unit (ICU) are particularly vulnerable to developing delirium. This study aims to determine the incidence and predictors of delirium among ICU patients at Jimma Medical Center in southwest Ethiopia in 2023.

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Methods: A prospective observational cohort study was conducted on 403 patients aged≥18 years admitted to emergency, surgical, and medical ICUs at Jimma Medical Center in southwest Ethiopia. Patients were assessed twice daily for delirium using the Richmond agitation sedation scale (RASS) and confusion assessment method (CAM). The association between independent variables and delirium incidence was analyzed using Cox proportional hazards (PH) regression. A univariate Cox PH model screened variables at a 0.25 significance level, followed by a multivariable Cox PH model for significant variables. Variables with a P-value≤0.05 were considered significantly associated with delirium incidence among ICU patients.

Results: The findings of this study revealed that the overall occurrence of delirium among critically ill ICU patients was 118 (29.3%) (95% CI: 25%,34%), and the rest, 70.7% of the participants, were censored (95% CI: 66,75). The incidence rate of delirium among intensive care unit patients was 21.2 (95% CI: 17.8,25.4) per 1000 person-days of observation. Chronic obstructive pulmonary disease (AHR: 1.94; 95% CI: 1.23,3.56), stroke (AHR: 1.8; 95%CI: 1.98,3.73), Oxygen Saturation less than 90% (AHR:1.61; 95% CI: 1.11,2.34) and Obesity (AHR: 0.35; 95%CI: 0.13,0.84) were independent predictors of delirium among ICU patients.

conclusion: This study found that, with an incidence rate of 21.2 occurrences per 1000 person-days of observation, delirium greatly affects the outcome of intensive care unit patients in the Jimma Medical Center. The study identifies several factors that independently predict the occurrence of delirium in ICU patients, including obesity, stroke, low oxygen saturation levels, and COPD. Interestingly, our findings suggest that admission for heart failure may have a protective effect against delirium. Therefore, health professionals ought to give special attention to patients with identified predictors.