by Krewulak, Karla D.;
Stelfox, Henry T.; Leigh, Jeanna Parsons; Ely, E. Wesley; Fiest, Kirsten M.
Objectives: Use
systematic review and meta-analytic methodology to estimate the pooled
incidence, prevalence, and proportion of delirium cases for each delirium
subtype (hypoactive, hyperactive, and mixed) in an adult ICU population.
Data Sources: We
conducted a search of the MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, and
PsycINFO databases following the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses standards from database inception until October 22,
2017, with no restrictions. Study Selection: We included original research
conducted in adults admitted to any medical, surgical, or speciality ICU that
reported incidence or prevalence estimates of delirium according to delirium
subtype.
Data Extraction: Data
were extracted on sample size, population demographics, condition information,
and reported delirium estimates.
Data Synthesis:
Forty-eight studies (27,342 patients; 4,550 with delirium) with an overall
pooled prevalence of 31% (95% CI, 24–41; I2 = 99%) met inclusion criteria. The
pooled incidence (n = 18 studies) of delirium subtypes were hyperactive (4%
[95% CI, 2–6]; I2 = 92%]), hypoactive (11% [95% CI, 8–17; I2 = 97%]), and mixed
(7% [95% CI, 4–11; I2 = 97%]). The pooled prevalence (n = 31 studies) of
delirium subtypes were hyperactive (4% [95% CI, 3–6; I2 = 94%]), hypoactive
(17% [95% CI, 13–22; I2 = 97%]), and mixed (10% [95% CI, 6–16; I2 = 99%]). The
pooled prevalence of hypoactive delirium in study populations with a similarly
high severity of illness or mechanically ventilated was higher (severity of
illness: 29% [95% CI, 18–46%; I2 = 95%], 100% mechanically ventilated: 35% [95%
CI, 23–55%; I2 = 93%]) compared with the pooled prevalence of hypoactive
delirium.
Conclusions:
Despite significant heterogeneity between studies, these data show the majority
of delirious ICU patients to have hypoactive delirium, a finding with potential
monitoring, management, and prognostic implications. The prevalence of
hypoactive delirium varies between-study populations and is higher in patients
with greater severity of illness.
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