Delirium, which frequently occurs in older ICU patients, increases morbidity, mortality, length and cost of hospital stay, and nursing home admission. To determine what characteristics present upon admission to the ICU were associated with the development of delirium within 48 hours, researchers at Yale-New Haven Hospital in Connecticut studied 304 adults ages 60 and over consecutively admitted to the medical ICU. Of the 214 patients (70%) who developed delirium within 48 hours, 152 developed it on the day of admission. After adjusting for confounding factors, developing delirium within 48 hours of admission to the ICU was most strongly associated with having a history of dementia, taking a benzodiazepine before admission, and having an arterial pH of less than 7.35 or a creatinine level of more than 2 mg/dL.
Based on these results, the authors suggest that older patients be screened for dementia upon ICU admission. Drugs and interventions that increase the likelihood of delirium can then be avoided and reorientation strategies known to prevent it can be instituted with dementia patients. In all older patients in the ICU, metabolic imbalances should be corrected promptly and benzodiazepines used conservatively to lessen the likelihood of developing delirium and shorten its duration.
Fran Mennick, BSN, RN
NewsCAPS
Early childhood intervention programs pay off, according to a report by Reynolds and colleagues in the August issue of Archives of Pediatrics and Adolescent Medicine. A school-based early childhood intervention program in Chicago for more than 1,500 low-income minority children born in 1979 or 1980 provided educational and family-support services between the ages of three and nine. At follow-up at age 24, the program continued to benefit participants' health and well-being. Compared with children who attended full-day kindergarten and had access to enriched resources only, program participants were more likely to have finished high school and attended a four-year college, be employed, and have health insurance. They were less likely to have been arrested for or convicted of a felony or violent crime and to have depressive symptoms. The intervention had no effect, however, on smoking or substance use by age 24.
MRSA (methicillin-resistantStaphylococcus aureus) remains a major threat, with infections in the United States increasing by 30% to 368,600 cases from 2004 to 2005, according to Statistical Brief #35 from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. The 2005 in-hospital death rate for patients with MRSA infection-4.7%-was more than twice that for non-MRSA patients, and MRSA patients were hospitalized for an average of 10 days, compared with 4.6 days for patients without MRSA. Among patients infected with MRSA, skin or subcutaneous tissue infection was the most common principal diagnosis at hospital admission, accounting for almost 19% of MRSA-related hospitalizations.