Completed Research Project
Acute confusional state in general surgery patients: A pilot study to determine characteristics and feasibility of measurement
Investigators: Nikoletti S, Smith
V, Helmes E, Marriott R & McPhee I.
Funding: The Nurses Board of Western Australia Innovation and Development Award ($5,000). Australian Research Council Small Grants Scheme ($9,872)
Abstract: Delirium or acute confusional state is a common and serious problem experienced by older patients during hospitalisation, especially after surgery. There is a lack of research comparing delirium in planned versus emergency general surgery. A descriptive correlational design was used. The sample consisted of 76 patients, 60 years of age or older, admitted to two surgical wards of a major teaching hospital in Australia. Delirium was assessed using the NEECHAM scale. The prevalence of delirium was 47%, with 36 patients developing delirium during the observation period. Among patients with delirium, the mean confusion scores for emergency patients were significantly lower at baseline (p=0.026) and day three (p=0.009) than for planned admission patients, indicating that emergency patients were more confused. Excluding patients who were confused on the first post-operative day only, the mean duration of delirium was 3.5 days (SD=1.69) for emergency patients compared with 2 days (SD=1.6) for planned admissions (p=0.016). Increasing age (p=0.038) and the presence of a urinary catheter (p=0.001) were the only variables in this study found to be significantly associated with the development of delirium. Delirium appears to have a greater impact on emergency patients compared with planned admissions. Some of the NEECHAM Scale items cannot be reliably distinguished from the direct effects of anaesthetics and analgesics. The significant association between the presence of a urinary catheter and delirium requires further study to determine the strength of the relationship and the underlying mechanism.