The DOI matches its Crossref record; 30 of the 31 references it cites were found in a registry or an index.
Delirium and Its Motoric Subtypes: A Study of 614 Critically Ill Patients
Abstract
OBJECTIVES: To describe the motoric subtypes of delirium in critically ill patients and compare patients aged 65 and older with a younger cohort. DESIGN: Prospective cohort study. SETTING: The medical intensive care unit (MICU) of a tertiary care academic medical center. PARTICIPANTS: Six hundred fourteen MICU patients admitted during a process improvement initiative to monitor levels of sedation and delirium. MEASUREMENTS: MICU nursing staff assessed delirium and level of consciousness in all MICU patients at least once per 12-hour shift using the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale. Delirium episodes were categorized as hypoactive, hyperactive, and mixed type. RESULTS: Delirium was detected in 112 of 156 (71.8%) subjects aged 65 and older and 263 of 458 (57.4%) subjects younger than 65. Mixed type was most common (54.9%), followed by hypoactive delirium (43.5%) and purely hyperactive delirium (1.6%). Patients aged 65 and older experienced hypoactive delirium at a greater rate than younger patients (41.0% vs 21.6%, P<.001) and never experienced hyperactive delirium. Older age was strongly and independently associated with hypoactive delirium (adjusted odds ratio=3.0, 95% confidence interval=1.7-5.3), compared with no delirium in a model that adjusted for other important determinants of delirium including severity of illness, sedative medication use, and ventilation status. CONCLUSION: Older age is a strong predictor of hypoactive delirium in MICU patients, and this motoric subtype of delirium may be missed in the absence of active monitoring.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Hyperactive delirium most often comes to clinical attention, but the mixed and hypoactive presentations are far more common [7,59,60,61].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [59]
Citations
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985) · Critical Care Medicine · doi:10.1097/00003246-198510000-00009 · Cited by 15,518
APACHE II-A Severity of Disease Classification System
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1986) · Critical Care Medicine · doi:10.1097/00003246-198608000-00028 · Cited by 13,379
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS
Teasdale, G., & Jennett, B. (1974) · The Lancet · doi:10.1016/s0140-6736(74)91639-0 · Cited by 13,215
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
DEYO, R. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90133-8 · Cited by 10,452
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., et al. (2001) · JAMA · doi:10.1001/jama.286.21.2703 · Cited by 3,210
Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit
Ely, E. W. (2004) · JAMA · doi:10.1001/jama.291.14.1753 · Cited by 3,073
A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients
Inouye, S. K., Bogardus, S. T., Charpentier, P. A., Leo-Summers, L. S., Acampora, D., Holford, T. R., & Cooney, L. M. (1999) · New England Journal of Medicine · doi:10.1056/nejm199903043400901 · Cited by 2,904
Monitoring Sedation Status Over Time in ICU Patients
Ely, E. W., Truman, B., Shintani, A., Thomason, J. W. W., Wheeler, A. P., Gordon, S., Francis, J., Speroff, T., Gautam, S., Margolin, R. A., et al. (2003) · JAMA · doi:10.1001/jama.289.22.2983 · Cited by 1,704
Inouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D., & Tinetti, M. E. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00005 · Cited by 854
Research works printed but not linked: 3
- McNicoll L, 2004, One‐year outcomes following delirium in older ICU patients [abstract], J Am Geriatr Soc, 52, S2
- Peterson JF, 2003, The prevalence of hypoactive, hyperactive, and mixed type delirium in medical ICU patients, J Am Geriatr Soc, 51, S174
- Truman B, 2003, Large‐scale implementation of delirium and sedation monitoring in the ICU, Am J Crit Care, 12, 288
Cited by
Sorted by citations
Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., Davidson, J. E., Devlin, J. W., Kress, J. P., Joffe, A. M., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182783b72 · Cited by 3,896
“ICU personnel often underestimate the presence of delirium in patients because it frequently presents as hypoactive rather than hyperactive delirium (377, 385).”
BackgroundSu, X. W., Meng, Z., Wu, X., Cui, F., Li, H.-L., Wang, D., Zhu, X. D., Zhu, S., Maze, M., & Ma, D. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30580-3 · Cited by 800
Postoperative Delirium in the Elderly
Robinson, T. N., Raeburn, C. D., Tran, Z. V., Angles, E. M., Brenner, L. A., & Moss, M. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e31818e4776 · Cited by 653
“The daily CAM-ICU Richmond Agitation-Sedation Scale scores were used to determine the motor subtype of delirium.(16) When only neutral or negative scores were recorded, hypoactive delirium was determined to be present.”
MethodDelirium in the intensive care unit
Girard, T. D., Pandharipande, P. P., & Ely, E. W. (2008) · Critical Care · doi:10.1186/cc6149 · Cited by 648
“and coworkers [15] examined delirium subtypes in a cohort of”
BackgroundSedation and Delirium in the Intensive Care Unit
Reade, M. C., & Finfer, S. R. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1208705 · Cited by 619
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness
Girard, T. D., Exline, M. C., Carson, S. S., Hough, C. L., Rock, P., Gong, M. N., Douglas, I. S., Malhotra, A., Owens, R. L., Feinstein, D., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1808217 · Cited by 589
“of patients (%) 50 (27) 50 (26) 53 (28)”
Pandharipande, P. P., Cotton, B. A., Shintani, A., Thompson, J. L., Pun, B. T., Morris, J. A., Dittus, R. S., & Ely, E. W. (2008) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e31814b2c4d · Cited by 560
Smith, H. A. B., Besunder, J. B., Betters, K. A., Johnson, P. N., Srinivasan, V., Stormorken, A., Farrington, E., Golianu, B. J., Godshall, A. J., Acinelli, L., et al. (2022) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002873 · Cited by 537
“Patients with hypoactive delirium may appear apathetic, withdrawn from the environment, or with depressed levels of arousal (215, 216), and rarely provoke concern despite being more likely to have poorer outcomes (215, 217, 218).”
BackgroundDevlin, J. W., Roberts, R. J., Fong, J. J., Skrobik, Y. K., Riker, R. R., Hill, N. S., Robbins, T., & Garpestad, E. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181b9e302 · Cited by 532
Pun, B. T., Badenes, R., Calle, G. H. L., Orun, O. M., Chen, W., Chandrasekhar, R., Simpson, B. K., Wilson-Linville, S., Olmedillo, B. H., de la Cueva, A. V., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30552-x · Cited by 543
Delirium in critical illness: clinical manifestations, outcomes, and management
Stollings, J. L., Kotfis, K., Chanques, G., Pun, B. T., Pandharipande, P. P., & Ely, E. W. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06503-1 · Cited by 571
Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes
Han, J. H., Zimmerman, E. E., Cutler, N. S., Schnelle, J. F., Morandi, A., Dittus, R. S., Storrow, A. B., & Ely, E. W. (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00339.x · Cited by 435
“Our findings are consistent with hospital-based studies.(28,44,45) Distinguishing delirium by its psychomotor subtypes is essential for several reasons.”
MethodResultPage, V. J., Ely, E. W., Gates, S., Zhao, X. B., Alce, T. M., Shintani, A., Jackson, J. C., Perkins, G. D., & McAuley, D. F. (2013) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(13)70166-8 · Cited by 409
Epidemiology and risk factors for delirium across hospital settings
Vasilevskis, E. E., Han, J. H., Hughes, C. G., & Ely, E. W. (2012) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2012.07.003 · Cited by 393
Hughes, C. G., Boncyk, C. S., Culley, D. J., Fleisher, L. A., Leung, J. M., McDonagh, D. L., Gan, T. J., McEvoy, M. D., Miller, T. E., & Workgroup, F. T. P. Q. I. (. 6. (2020) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000004641 · Cited by 405
Krewulak, K. D., Stelfox, H. T., Leigh, J. P., Ely, E. W., & Fiest, K. M. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003402 · Cited by 424
Dorman, T. (2011) · Yearbook of Critical Care Medicine · doi:10.1016/s0734-3299(10)79437-5 · Cited by 385
Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium
Traube, C., Silver, G., Gerber, L. M., Kaur, S., Mauer, E. A., Kerson, A., Joyce, C., & Greenwald, B. M. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002324 · Cited by 379
“The first is the classification of delirium by subtype (hyperactive, hypoactive, and mixed), which has been intensively investigated in the adult literature(1,26,27).”
Backgroundvan den Boogaard, M., Schoonhoven, L., Evers, A. W. M., van der Hoeven, J. G., van Achterberg, T., & Pickkers, P. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e31822e9fc9 · Cited by 361
“Patients with delirium were divided into three subtypes (3): hyperactive delirium subtype with symptoms of hyperalertness and agitation (Richmond Agitation Sedation Scale 1/ 4); hypoactive subtype in which the patient is hypoalert, lethargic (Richmond Agitation Sedation Scale 0/-3); and the alternating or mixed subtyp…”
BackgroundMethodSeptic-Associated Encephalopathy: a Comprehensive Review
Mazeraud, A., Righy, C., Bouchereau, E., Benghanem, S., Bozza, F. A., & Sharshar, T. (2020) · Neurotherapeutics · doi:10.1007/s13311-020-00862-1 · Cited by 352
“Thus, a severe sickness behavior can mimic a hypoactive delirium [86].”
BackgroundSmith, H. A. B., Boyd, J., Fuchs, D. C., Melvin, K. E., Berry, P., Shintani, A., Eden, S., Terrell, M. K., Boswell, T., Wolfram, K. B., et al. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181feb489 · Cited by 334
Comparison of delirium assessment tools in a mixed intensive care unit*
van Eijk, M. M. J., van Marum, R. J., Klijn, I., de Wit, N., Kesecioğlu, J., & Slooter, A. J. C. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181a00118 · Cited by 333
“Previous studies suggest that older patients with hypoactive delirium in the ICU are often misdiagnosed (24).”
ResultDAS-Taskforce, Baron, R., Binder, A., Biniek, R., Braune, S. A., Buerkle, H., Dall, P., Demirakca, S., Eckardt, R., Eggers, V., et al. (2015) · Europe PMC (PubMed Central) · doi:10.3205/000223 · Cited by 339
“Upgrading: hohe klinische Relevanz [272] 2b [119] 2b [120] 2b A”
Patel, R. P., Gambrell, M., Speroff, T., Scott, T. A., Pun, B. T., Okahashi, J., Strength, C., Pandharipande, P. P., Girard, T. D., Burgess, H., et al. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e31819b8608 · Cited by 319
“This is especially true for hypoactive or “quiet” delirium, which is often the most prevalent form of delirium in ICU studies (10, 30, 31).”
BackgroundDelirium in the ICU and Subsequent Long-Term Disability Among Survivors of Mechanical Ventilation*
Brummel, N. E., Jackson, J. C., Pandharipande, P. P., Thompson, J. L., Shintani, A., Dittus, R. S., Gill, T. M., Bernard, G. R., Ely, E. W., & Girard, T. D. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182a645bd · Cited by 310
“, with reduced physical activity) (38, 39).”
The Importance of Diagnosing and Managing ICU Delirium
Pun, B. T., & Ely, E. W. (2007) · Chest · doi:10.1378/chest.06-1795 · Cited by 287
Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study
van Eijk, M. M. J., van den Boogaard, M., van Marum, R. J., Benner, P., Eikelenboom, P., Honing, M. L. H., van der Hoven, B., Horn, J., Izaks, G. J., Kalf, A., et al. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201101-0065oc · Cited by 285
Vasilevskis, E. E., Ely, E. W., Speroff, T., Pun, B. T., Boehm, L. M., & Dittus, R. S. (2010) · CHEST Journal · doi:10.1378/chest.10-0466 · Cited by 280
Bench-to-bedside review: Delirium in ICU patients - importance of sleep deprivation
Weinhouse, G. L., Schwab, R. J., Watson, P. L., Patil, N., Vaccaro, B., Pandharipande, P. P., & Ely, E. W. (2009) · Critical Care · doi:10.1186/cc8131 · Cited by 276
“Patients may be agitated (hyperactive delirium), may be withdrawn (hypoactive or quiet delirium), or may have features of both agitation and withdrawal at times [1].”
BackgroundDelirium in the Cardiovascular ICU
McPherson, J., Wagner, C. E., Boehm, L. M., Hall, J. D., Johnson, D., Miller, L. R., Burns, K., Thompson, J. L., Shintani, A., Ely, E. W., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e31826ab49b · Cited by 277
Nurse practitioners and physician assistants in the intensive care unit: An evidence-based review
Kleinpell, R. M., Ely, E. W., & Grabenkort, R. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e318186ba8c · Cited by 275
Delirium in the ICU: an overview
Cavallazzi, R., Saad, M., & Marik, P. E. (2012) · Annals of Intensive Care · doi:10.1186/2110-5820-2-49 · Cited by 275
“The two most common types of delirium in the ICU are mixed and hypoactive [11].”
BackgroundPandharipande, P. P., Cotton, B. A., Shintani, A., Thompson, J. L., Costabile, S., Pun, B. T., Dittus, R. S., & Ely, E. W. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0687-y · Cited by 268
Sleep and delirium in ICU patients: a review of mechanisms and manifestations
Figueroa-Ramos, M. I., Arroyo-Novoa, C. M., Lee, K. A., Padilla, G., & Puntillo, K. (2009) · Intensive Care Medicine · doi:10.1007/s00134-009-1397-4 · Cited by 278
Motor Subtypes of Postoperative Delirium in Older Adults
Robinson, T. N. (2011) · Archives of Surgery · doi:10.1001/archsurg.2011.14 · Cited by 250
“Motor subtypes of delirium were defined using daily RASS scores as previously described.(13,14) Hyperactive delirium was defined as present in patients with all positive daily RASS scores (range, 1-4 points) associated with every positive CAM-ICU assessment.”
InfluentialPrevention and Management of Delirium in the Intensive Care Unit
Mart, M. F., Roberson, S. W., Salas, B., Pandharipande, P. P., & Ely, E. W. (2020) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0040-1710572 · Cited by 300
van den Boogaard, M., Schoonhoven, L., van der Hoeven, J. G., van Achterberg, T., & Pickkers, P. (2011) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.11.016 · Cited by 231
“Although the classification of the delirium subtypes according to Peterson et al. (2006) is commonly used in the ICU, little is known about incidence rates of the subtypes per ICU diagnosis group and its effects on delirium duration and short-term consequences.”
BackgroundMethodInfluentialDelirium assessment in the critically ill
Devlin, J. W., Fong, J. J., Fraser, G. L., & Riker, R. R. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0603-5 · Cited by 222
“, psychomotor slowing) or have a mixed picture [26, 27].”
BackgroundMotor subtypes of delirium: Past, present and future
Meagher, D. J. (2009) · International Review of Psychiatry · doi:10.1080/09540260802675460 · Cited by 214
“Studies suggest that relative hypoactivity is associated with a range of factors including frailty, severity of physical illness, comorbid dementia, and older age (O’Keeffe & Lavan, 1999; Peterson et al., 2006), see Figure 2.”
BackgroundValidity and Reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients
Guenther, U., Popp, J., Koecher, L., Muders, T., Wrigge, H., Ely, E. W., & Putensen, C. (2009) · Journal of Critical Care · doi:10.1016/j.jcrc.2009.08.005 · Cited by 213
“In keeping with other reports, most of the delirium episodes were hypoactive (“quiet delirium”), which tend to be “invisible” and, therefore, missed in the absence of routine monitoring [38,44].”
ResultJanssen, T. L., Alberts, A. R., Hooft, L., Mattace-Raso, F. U. S., Mosk, C. A., & van der Laan, L. (2019) · Clinical Interventions in Aging · doi:10.2147/cia.s201323 · Cited by 220
Assessment of Delirium in the Intensive Care Unit: Nursing Practices And Perceptions
Devlin, J. W., Fong, J. J., Howard, E., Skrobik, Y. K., McCoy, N., Yasuda, C., & Marshall, J. (2008) · American Journal of Critical Care · doi:10.4037/ajcc2008.17.6.555 · Cited by 211
The intensive care delirium research agenda: a multinational, interprofessional perspective
Pandharipande, P. P., Ely, E. W., Arora, R. C., Balas, M. C., Boustani, M. A., Calle, G. H. L., Cunningham, C. M., Devlin, J. W., Elefante, J., Han, J. H., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4860-7 · Cited by 215
“A substantial proportion of ICU patients have hypoactive delirium [5], and hypoactive delirium may portend worse outcomes than hyperactive delirium [6].”
BackgroundSchön, J., Meyerrose, J., Paarmann, H., Heringlake, M., Hueppe, M., & Berger, K.-U. (2011) · Critical Care · doi:10.1186/cc10454 · Cited by 207
“Whereas the hyperactive form of delirium is easily recognized, the much more frequent hypoactive form is often missed by nurses and intensive care physicians [7,8].”
BackgroundICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit
Kotfis, K., Marra, A., & Ely, E. W. (2018) · Anaesthesiology Intensive Therapy · doi:10.5603/ait.a2018.0011 · Cited by 220
“According to the type of symptoms, delirium can be categorized into three subtypes: hyperactive, hypoactive and mixed [10].”
BackgroundMorandi, A., Pandharipande, P. P., Trabucchi, M., Rozzini, R., Mistraletti, G., Trompeo, A. C., Gregoretti, C., Gattinoni, L., Ranieri, M. V., Brochard, L. J., et al. (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1177-6 · Cited by 201
“Delirium is classified according to motoric (psychomotor) subtypes as hyperactive delirium, hypoactive delirium and mixed delirium [6, 7, 32, 33].”
BackgroundPatient-Focused Sedation and Analgesia in the ICU
Sessler, C. N., & Gill, K. V. (2008) · CHEST Journal · doi:10.1378/chest.07-2026 · Cited by 191
Martin, J., Heymann, A., Bäsell, K., Baron, R., Biniek, R., Bürkle, H., Dall, P., Dictus, C., Eggers, V., Eichler, I., et al. (2010) · PubMed Central · doi:10.3205/000091 · Cited by 184
“• Es soll ein regelmäßiges gezieltes Screening auf delirante Symptome mit einem geeigneten Delir-Score durchgeführt werden [12] [83] [84].”
BackgroundInfluentialPrevalence and Risk Factors for Development of Delirium in Burn Intensive Care Unit Patients
Agarwal, V., O’Neill, P. J., Cotton, B. A., Pun, B. T., Haney, S., Thompson, J. L., Kassebaum, N. J., Shintani, A., Guy, J., Ely, E. W., et al. (2010) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e3181eebee9 · Cited by 185
“Similarly, the prevalence rates and subtypes of delirium were in line with those reported earlier in nonburn patients.(7,26,35) A unique finding in this study was that intravenous opiate administration (fentanyl and morphine) reduced the odds of development of delirium by half.”
ResultHayhurst, C. J., Pandharipande, P. P., & Hughes, C. G. (2016) · Anesthesiology · doi:10.1097/aln.0000000000001378 · Cited by 192
Assessment scales for delirium: A review
Grover, S. (2012) · World Journal of Psychiatry · doi:10.5498/wjp.v2.i4.58 · Cited by 183
Cunningham, C. M., & MacLullich, A. M. J. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.07.012 · Cited by 181
“Is it possible for infection, which we so often associate with suppressed activity, to induce hyperactive or agitated states? In one study of 614 delirium cases in critically ill patients, less than 2% of these patients showed pure hyperactive delirium, although as many as 55% showed mixed subtype and 44% were hypoact…”
InfluentialKiely, D. K., Jones, R. N., Bergmann, M. A., & Marcantonio, E. R. (2007) · The Journals of Gerontology Series A · doi:10.1093/gerona/62.2.174 · Cited by 171
Li, Y., Li, H.-J., Li, H., Zhao, B.-J., Guo, X., Feng, Y., Zuo, M., Yu, Y.-P., Kong, H., Zhao, Y., et al. (2021) · Anesthesiology · doi:10.1097/aln.0000000000003834 · Cited by 167
Devlin, J. W., Marquis, F., Riker, R. R., Robbins, T., Garpestad, E., Fong, J. J., Didomenico, D., & Skrobik, Y. K. (2008) · Critical Care · doi:10.1186/cc6793 · Cited by 161
“Given the fluctuating nature of delirium symptoms, the bedside nurse is the ICU caregiver best suited to screen for delirium [5-8].”
BackgroundAltered Mental Status in Older Patients in the Emergency Department
Han, J. H., & Wilber, S. T. (2012) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2012.09.005 · Cited by 158
Implementing Delirium Screening in the ICU
Brummel, N. E., Vasilevskis, E. E., Han, J. H., Boehm, L. M., Pun, B. T., & Ely, E. W. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31829a6f1e · Cited by 158
“Delirium presents as three major subtypes, hyperactive (agitated), hypoactive (quiet), and mixed (features of both hyperactive and h ypoactive), with hypoactive and mixed the most common presentations in critically ill patients (14, 15).”
BackgroundSmith, H. A. B., Gangopadhyay, M., Goben, C. M., Jacobowski, N., Chestnut, M. H., Thompson, J. L., Chandrasekhar, R., Williams, S. R., Griffith, K., Ely, E. W., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002515 · Cited by 161
Sepsis-Associated Encephalopathy: from Pathophysiology to Progress in Experimental Studies
Catarina, A. V., Branchini, G., Bettoni, L., De Oliveira, J. R., & Nunes, F. B. (2021) · Molecular Neurobiology · doi:10.1007/s12035-021-02303-2 · Cited by 155
Oh, S.-T., & Park, J. Y. (2018) · Korean Journal of Anesthesiology · doi:10.4097/kja.d.18.00073.1 · Cited by 160
“Some evidence suggested that certain risk factors such as preexisting cognitive impairment, older age, frailty, and severity of physical illness are more associated with hypoactive delirium [11,12].”
BackgroundBienvenu, O. J., Gellar, J. E., Althouse, B. M., Colantuoni, E., Sricharoenchai, T., Méndez-Téllez, P. A., Shanholtz, C. B., Himmelfarb, C. D., Pronovost, P. J., & Needham, D. M. (2013) · Psychological Medicine · doi:10.1017/s0033291713000214 · Cited by 152
“agitation and physical restraint in the ICU have been associated with both delirium/coma (Kollef et al. 1998; Micek et al. 2005; Pandharipande et al. 2006, 2007, 2008; Peterson et al. 2006; Payen et al. 2007; Weinert & Calvin, 2007; Arroliga et al. 2008; Riker et al. 2009) and later PTSD symptoms (Nelson et al.”
BackgroundRengel, K. F., Pandharipande, P. P., & Hughes, C. G. (2018) · La Presse Médicale · doi:10.1016/j.lpm.2018.03.012 · Cited by 149
Recognizing Delirium Superimposed on Dementia: Assessing Nurses' Knowledge Using Case Vignettes
Fick, D. M., Hodo, D. M., Lawrence, F., & Inouye, S. K. (2007) · Journal of Gerontological Nursing · doi:10.3928/00989134-20070201-09 · Cited by 146
“However, both the presence of dementia and the motoric subtype of hypoactive delirium have been found to be factors contributing to the under-recognition of delirium in previous studies (Inouye et al., 2001; Peterson et al., 2006).”
BackgroundDelayed Treatment of Delirium Increases Mortality Rate in Intensive Care Unit Patients
Heymann, A., Radtke, F. M., Schiemann, A., Luetz, A., MacGuill, M., Wernecke, K.-D., & Spies, C. (2010) · Journal of International Medical Research · doi:10.1177/147323001003800503 · Cited by 142
Chaiwat, O., Chanidnuan, M., Pancharoen, W., Vijitmala, K., Danpornprasert, P., To-adithep, P., & Thanakiattiwibun, C. (2019) · BMC Anesthesiology · doi:10.1186/s12871-019-0694-x · Cited by 149
Sharma, A. D., Malhotra, S., Grover, S., & Jindal, S. K. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2012.06.009 · Cited by 138
“[39].”
ResultThe Pain, Agitation, and Delirium Care Bundle
Barr, J. A., & Pandharipande, P. P. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182a16ff0 · Cited by 136
A research algorithm to improve detection of delirium in the intensive care unit
Pisani, M. A., Araujo, K. L. B., Ness, P. H. V., Zhang, Y., Ely, E. W., & Inouye, S. K. (2006) · Critical Care · doi:10.1186/cc5027 · Cited by 136
“Two recent publications [15,16] evaluated delirium more than once a day in the ICU.”
Haloperidol prophylaxis in critically ill patients with a high risk for delirium
van den Boogaard, M., Schoonhoven, L., van Achterberg, T., van der Hoeven, J. G., & Pickkers, P. (2013) · Critical Care · doi:10.1186/cc11933 · Cited by 133
“Patients with delirium were divided into three subtypes [19] as measured during the complete delirium period: hyperactive (Richmond agitation sedation score (RASS) [20] +1/+4), hypoactive (RASS 0/-3), and mixed (RASS +4/-3).”
BackgroundMethodTobar, E. A., Romero, C. M., Galleguillos, T. G. B., Fuentes, P., Cornejo, R., Lira, M. T., de la Barrera, L., Sánchez, J. E., Bozán, F., Bugedo, G. J., et al. (2009) · Medicina Intensiva · doi:10.1016/j.medin.2009.04.003 · Cited by 131
Risk factors for intensive care delirium: A systematic review
Rompaey, B. V., Schuurmans, M. J., Shortridge‐Baggett, L. M., Truijen, S., & Bossaert, L. L. (2007) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2007.08.005 · Cited by 130
Interventions for preventing intensive care unit delirium in adults
Herling, S. F., Greve, I. E., Vasilevskis, E. E., Egerod, I., Mortensen, C. B., Møller, A. M., Svenningsen, H., & Thomsen, T. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009783.pub2 · Cited by 141
Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients
Hipp, D. M., & Ely, E. W. (2012) · Neurotherapeutics · doi:10.1007/s13311-011-0102-9 · Cited by 134
“A high 5-HT2A/D2 receptor affinity ratio, which is a particularly strong characteristic of ziprasidone, has been correlated with lower propensity for extrapyramidal symptoms (EPS) and may be advantageous in treating the negative symptoms so prevalent in older hypoactive delirious patients [24, 85].”
BackgroundDelirium in Pediatric Critical Care
Patel, A. K., Bell, M. J., & Traube, C. (2017) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2017.06.009 · Cited by 122
Delirium in the Older Emergency Department Patient: A Quiet Epidemic
Han, J. H., Wilson, A., & Ely, E. W. (2010) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2010.03.005 · Cited by 124
Risk factors and outcomes among delirium subtypes in adult ICUs: A systematic review
Krewulak, K. D., Stelfox, H. T., Ely, E. W., & Fiest, K. M. (2020) · Journal of Critical Care · doi:10.1016/j.jcrc.2020.01.017 · Cited by 131
Soja, S. L., Pandharipande, P. P., Fleming, S. B., Cotton, B. A., Miller, L. R., Weaver, S. G., Lee, B. T., & Ely, E. W. (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1031-x · Cited by 121
“This difficulty in diagnosis is partly a result of the predominance of the “quiet” or hypoactive form of delirium, which is characterized by negative symptoms including lethargy and inattention, rather than the overt positive symptoms of hyperactive delirium such as agitation and pulling out lines and tubes that may c…”
BackgroundDelirium in critically ill patients
Slooter, A. J. C., van de Leur, R. R., & Zaal, I. J. (2017) · Handbook of clinical neurology · doi:10.1016/b978-0-444-63599-0.00025-9 · Cited by 125
Cognitive impairment and pain management: Review of issues and challenges
Buffum, M. D., Hutt, E., Chang, V. T., Craine, M. H., & Snow, A. L. (2007) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2006.06.0064 · Cited by 91
“6%) [91].”
Collet, M. O., Caballero, J., Sonneville, R., Bozza, F. A., Nydahl, P., Schandl, A., Wøien, H., Citerio, G., van den Boogaard, M., Hästbacka, J., et al. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5204-y · Cited by 114
Delirium in Critically Ill Patients
Zaal, I. J., & Slooter, A. J. C. (2012) · Drugs · doi:10.2165/11635520-000000000-00000 · Cited by 110
“In the same cohorts, 56% (range 45–64%) experienced hypoactive delirium, characterized by slowing or lack of movement, apathy and diminished responsiveness.([2,26,27]) Mixed delirium alternates between hyper- and hypoactive periods and represented 23% (range 6–55%) of the cases.”
BackgroundInfluentialNishida, O., Ogura, H., Egi, M., Fujishima, S., Hayashi, Y., Iba, T., Imaizumi, H., Inoue, S., Kakihana, Y., Kotani, J., et al. (2018) · Journal of Intensive Care · doi:10.1186/s40560-017-0270-8 · Cited by 107
Cognitive Dysfunction, Delirium, and Stroke in Cardiac Surgery Patients
Cropsey, C. L., Kennedy, J. A., Han, J. H., & Pandharipande, P. P. (2015) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/1089253215570062 · Cited by 105
“In critically ill patients, hypoactive and mixed-type are the commonly observed subtypes, while purely hyperactive delirium occurs in less than 2% of cases.(31,32) While the hyperactive type is perhaps more readily identifiable, the hypoactive type is far more prevalent in critically ill patients and portends worse ou…”
BackgroundA national survey of the management of delirium in UK intensive care units
Sweeney, R. M., Barber, V. S., Page, V. J., Ely, E. W., Perkins, G. D., Young, D., & McAuley, D. F. (2010) · QJM · doi:10.1093/qjmed/hcp194 · Cited by 106
Association of Hypoactive and Hyperactive Delirium With Cognitive Function After Critical Illness
Hayhurst, C. J., Marra, A., Han, J. H., Patel, M. B., Brummel, N. E., Thompson, J. L., Jackson, J. C., Chandrasekhar, R., Ely, E. W., Pandharipande, P. P., et al. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004313 · Cited by 115
“Using previously published criteria (7, 15), we defined a day with hypoactive delirium as a day with a positive CAM-ICU and corresponding RASS less than or equal to 0 and a day with hyperactive delirium as a day with a positive CAM-ICU and corresponding RASS greater than 0.”
BackgroundMethodNeuroanatomy and Physiology of Brain Dysfunction in Sepsis
Mazeraud, A., Pascal, Q., Verdonk, F., Heming, N., Chrétien, F., & Sharshar, T. (2016) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2016.01.013 · Cited by 107
Patterns of Postoperative Delirium in Children
Meyburg, J., Dill, M.-L., Traube, C., Silver, G., & von Haken, R. (2017) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000000993 · Cited by 100
Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC
Hænggi, M., Blum, S., Brechbuehl, R., Brunello, A., Jakob, S. M., & Takala, J. A. (2013) · Intensive Care Medicine · doi:10.1007/s00134-013-3034-5 · Cited by 100
Smith, H. A. B., Brink, E., Fuchs, D. C., Ely, E. W., & Pandharipande, P. P. (2013) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2013.02.010 · Cited by 98
Seven lessons from 20 years of follow-up of intensive care unit survivors
Griffiths, R. D., & Jones, C. (2007) · Current Opinion in Critical Care · doi:10.1097/mcc.0b013e3282efae05 · Cited by 98
Depression and end-of-life care for patients with cancer
Rosenstein, D. L. (2011) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2011.13.1/drosenstein · Cited by 92
“Hypoactive delirium is the most common subtype of delirium, and particularly likely to be mistaken for depression.(15-21) Prescribing an antidepressant or a psychostimulant to a patient who is withdrawn as a result of delirium, rather than depression, is more likely to exacerbate the delirium than alleviate depressive…”
Maniar, H. S., Lindman, B. R., Escallier, K. E., Avidan, M. S., Novak, E. L., Melby, S. J., Damiano, M. S., Lasala, J. M., Quader, N., Rao, R. S., et al. (2015) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2015.10.114 · Cited by 95
“Delirium episodes were further classified as hypoactive, hyperactive, or mixed by using the Richmond Agitation and Sedation Scale (RASS) documented at the time of the delirium assessment.(16,17) The RASS is a 10-point sedation scale that measures level of consciousness.”
Delirium in the intensive care unit
El-Menyar, A. A., Arumugam, S., Al‐Hassani, A., Strandvik, G. F., Asim, M., Mekkodathil, A. A., Mudali, I. N., & Al-Thani, H. A. S. (2017) · Journal of Emergencies Trauma and Shock · doi:10.4103/0974-2700.199520 · Cited by 95
“It appears to result in greater need for MV, prolonged ICU length of stay, and increased risk of mortality in comparison to hyperactive delirium.[15,17,18] Hypoactive and mixed types are the two frequently observed types in ICU patients.”
BackgroundInfluentialHan, J. H., Bryce, S., Ely, E. W., Kripalani, S. B., Morandi, A., Shintani, A., Jackson, J. C., Storrow, A. B., Dittus, R. S., & Schnelle, J. F. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.12.002 · Cited by 92
Delirium in the intensive care unit
Morandi, A., Jackson, J. C., & Ely, E. W. (2009) · International Review of Psychiatry · doi:10.1080/09540260802675296 · Cited by 100
“ICU researchers have directed their attention to two other aspects of the categorization of delirium such as delirium subtypes (Pandharipande et al., 2007; Peterson et al., 2006) and sub-syndromal delirium (Ouimet et al.”
BackgroundEertmans, W., Deyne, C. D., Genbrugge, C., Marcus, B., Bouneb, S., Beran, M., Fret, T., Gutermann, H., Boer, W., Laenen, M. V., et al. (2019) · British Journal of Anaesthesia · doi:10.1016/j.bja.2019.09.042 · Cited by 93
Gusmao-Flores, D., Salluh, J. I., Dal‐Pizzol, F., Ritter, C., Tomasi, C. D., Lima, M. A., Santana, L. R., Lins, R. M. P., Lemos, P. P., Serpa, G., et al. (2011) · PubMed Central · doi:10.1590/s1807-59322011001100011 · Cited by 94
Delirium in Critically Ill Patients
Jackson, P., & Khan, A. (2015) · Critical Care Clinics · doi:10.1016/j.ccc.2015.03.011 · Cited by 94
Prediction of delirium in critically ill patients with elevated C-reactive protein
Zhang, Z., Pan, L., Deng, H., Ni, H., & Xu, X. (2013) · Journal of Critical Care · doi:10.1016/j.jcrc.2013.09.002 · Cited by 87
“Patients with delirium were categorized into hyperactive (persistent positive RASS values: +1 to +4 during all assessments), hypoactive (persistently neutral or negative RASS values: 0 to −3 during all assessments), and mixed types of delirium (episode with both positive and negative RASS values) according to RASS ass…”
MethodDelirium: An emerging frontier in the management of critically ill children
Smith, H. A. B., Fuchs, D. C., Pandharipande, P. P., Barr, F. E., & Ely, E. W. (2009) · Critical Care Clinics · doi:10.1016/j.ccc.2009.05.002 · Cited by 87
“Am J Psychiatry 1982;139(11):1460– 1462.”
Self-citation
Metadata
- Authors
- Peterson, J. F., Pun, B. T., Dittus, R. S., Thomason, J. W. W., Jackson, J. C., Shintani, A. K., & Ely, E. W.
- Affiliations
- Vanderbilt University Medical Center (US)
- VA Tennessee Valley Healthcare System (US)
- Corresponding author
- Peterson, Josh F.
- Ely, E. Wesley
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2006-03
- Volume
- 54
- Issue
- 3
- Pages
- 479-484
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1505808688
- Cited by
- 660
- References
- 31
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 32 · 2023: 37 · 2022: 21 · 2021: 33 · 2020: 32 · 2019: 45 · 2018: 44 · 2017: 41 · 2016: 48 · 2015: 37 · 2014: 29 · 2013: 42 · 2012: 44
- FWCI
- 27.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- delirium, hypoactive delirium, hyperactive delirium, mixed delirium, critically ill patients, older adults, intensive care unit, age as predictor, sedation, level of consciousness, delirium monitoring
- MeSH terms
- Age Factors, Aged, Critical Care, Delirium, Female, Follow-Up Studies, Humans, Male, Motor Activity, Prognosis, Prospective Studies, Severity of Illness Index, Incidence, Prevalence, Critical Illness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
