Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts
Introduction: Atypical antipsychotics are frequently initiated in the intensive care unit (ICU) to treat delirium. Many patients continue on these agents at hospital discharge despite a lack of data to support long-term use. Objectives: The primary aim of this study was to determine underlying risk...
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| Veröffentlicht in: | Clinical medicine insights. Psychiatry 2019-01, Vol.10 |
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| creator | Levine, Alexander R Lemieux, Steven M D’Aquino, Daniela Tenney, Analise Pisani, Margaret Ali, Syed |
| description | Introduction:
Atypical antipsychotics are frequently initiated in the intensive care unit (ICU) to treat delirium. Many patients continue on these agents at hospital discharge despite a lack of data to support long-term use.
Objectives:
The primary aim of this study was to determine underlying risk factors for continuation of antipsychotics at hospital discharge in medical intensive care unit (MICU) and surgical intensive care unit (SICU) patients when evaluated as separate cohorts.
Methods:
A single-center, retrospective study in patients newly initiated on quetiapine, risperidone, or olanzapine in a 22-bed mixed medical-surgical ICU admitted from January 2017 to July 2018.
Results:
A total of 78 (62.9%) MICU patients and 46 (37.1%) SICU patients met the inclusion criteria during this time frame. A total of 29 MICU patients (37.2%) were prescribed antipsychotics at hospital discharge compared to 25 SICU patients (54.3%), P = .063. The percentage of MICU patients prescribed antipsychotics at hospital discharge was significantly higher in patients ⩾60 years of age (22 [75.9%] vs 26 [53.1%], P = .045), with a history of dementia (5 [17.2%] vs 1 [2%], P = .015), admitted with hemorrhagic stroke (5 [17.2%] vs 2 [4.1%], P = .049), and initiated on risperidone (3 [10.3%] vs 0%, P = .022). The risk of pre-existing dementia remained significant in a multivariate logistic regression that controlled for confounding variables, odds ratio (OR) = 10 (95% confidence interval [CI]: 1.11-90.5, P = .040). The percentage of SICU patients prescribed antipsychotics at discharge was significantly higher in those with severe traumatic brain injury (TBI; 8 [72.7%] vs 0%, P = .004) and initiated on quetiapine (19 [76%] vs 9 [42.9%], P = .022).
Conclusion:
Antipsychotics were commonly continued at hospital discharge in both MICU and SICU patients. Several risk factors for continuation of antipsychotics were identified in these two cohorts. Future efforts assessing the appropriateness of antipsychotics at transitions of care are warranted. |
| doi_str_mv | 10.1177/1179557319863813 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2421469215</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1179557319863813</sage_id><sourcerecordid>2331589883</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2243-b13783827e023b7813986dd124e32b0704b144b8d0fcf59a47f4986d91b7d5a03</originalsourceid><addsrcrecordid>eNp9kc1LAzEQxYMoWGrvHgOeV_O1TfZYVmsLBUHa85LNZtvUmmyTVOl_3ywVFEEvSXj5zZt5DAC3GN1jzPlDOoo85xQXYkwFphdg0EtZr13-eF-DUQhbhBBGHJGCD8D-1YQ3OJUqOh9g6zwsnY3GHmQ0zkLXwkk8dkbJHZwkvQtHtXHRqABlhDMXOhPT16MJaiP9WkNj4fLTwbmN2gbzoWEpvYYra2Iy3jgfww24auUu6NHXPQSr6dOynGWLl-d5OVlkihBGsxpTLqggXCNCa55CpWxNgwnTlNRpfFZjxmrRoFa1eSEZb1lPFLjmTS4RHYK7s2_n3f6gQ6y27uBtalkRRjAbFwTn_1KU4lwUQtBEoTOlvAvB67bqvHmX_lhhVPUbqH5vIJVk55Ig1_rb9E_-BGttg7Y</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2421469215</pqid></control><display><type>article</type><title>Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts</title><source>EZB-FREE-00999 freely available EZB journals</source><creator>Levine, Alexander R ; Lemieux, Steven M ; D’Aquino, Daniela ; Tenney, Analise ; Pisani, Margaret ; Ali, Syed</creator><creatorcontrib>Levine, Alexander R ; Lemieux, Steven M ; D’Aquino, Daniela ; Tenney, Analise ; Pisani, Margaret ; Ali, Syed</creatorcontrib><description>Introduction:
Atypical antipsychotics are frequently initiated in the intensive care unit (ICU) to treat delirium. Many patients continue on these agents at hospital discharge despite a lack of data to support long-term use.
Objectives:
The primary aim of this study was to determine underlying risk factors for continuation of antipsychotics at hospital discharge in medical intensive care unit (MICU) and surgical intensive care unit (SICU) patients when evaluated as separate cohorts.
Methods:
A single-center, retrospective study in patients newly initiated on quetiapine, risperidone, or olanzapine in a 22-bed mixed medical-surgical ICU admitted from January 2017 to July 2018.
Results:
A total of 78 (62.9%) MICU patients and 46 (37.1%) SICU patients met the inclusion criteria during this time frame. A total of 29 MICU patients (37.2%) were prescribed antipsychotics at hospital discharge compared to 25 SICU patients (54.3%), P = .063. The percentage of MICU patients prescribed antipsychotics at hospital discharge was significantly higher in patients ⩾60 years of age (22 [75.9%] vs 26 [53.1%], P = .045), with a history of dementia (5 [17.2%] vs 1 [2%], P = .015), admitted with hemorrhagic stroke (5 [17.2%] vs 2 [4.1%], P = .049), and initiated on risperidone (3 [10.3%] vs 0%, P = .022). The risk of pre-existing dementia remained significant in a multivariate logistic regression that controlled for confounding variables, odds ratio (OR) = 10 (95% confidence interval [CI]: 1.11-90.5, P = .040). The percentage of SICU patients prescribed antipsychotics at discharge was significantly higher in those with severe traumatic brain injury (TBI; 8 [72.7%] vs 0%, P = .004) and initiated on quetiapine (19 [76%] vs 9 [42.9%], P = .022).
Conclusion:
Antipsychotics were commonly continued at hospital discharge in both MICU and SICU patients. Several risk factors for continuation of antipsychotics were identified in these two cohorts. Future efforts assessing the appropriateness of antipsychotics at transitions of care are warranted.</description><identifier>ISSN: 1179-5573</identifier><identifier>EISSN: 1179-5573</identifier><identifier>DOI: 10.1177/1179557319863813</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Age ; Alcohol ; Anesthesia ; Antipsychotics ; Catheters ; Delirium ; Dementia ; Geriatrics ; Hospitals ; Illnesses ; Intensive care ; Medical records ; Patients ; Physical restraints ; Psychotropic drugs ; Risk factors ; Trauma ; Traumatic brain injury ; Ventilators</subject><ispartof>Clinical medicine insights. Psychiatry, 2019-01, Vol.10</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019. This work is licensed under the Creative Commons Attribution – Non-Commercial License http://www.creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2243-b13783827e023b7813986dd124e32b0704b144b8d0fcf59a47f4986d91b7d5a03</citedby><cites>FETCH-LOGICAL-c2243-b13783827e023b7813986dd124e32b0704b144b8d0fcf59a47f4986d91b7d5a03</cites><orcidid>0000-0002-8838-1332</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Levine, Alexander R</creatorcontrib><creatorcontrib>Lemieux, Steven M</creatorcontrib><creatorcontrib>D’Aquino, Daniela</creatorcontrib><creatorcontrib>Tenney, Analise</creatorcontrib><creatorcontrib>Pisani, Margaret</creatorcontrib><creatorcontrib>Ali, Syed</creatorcontrib><title>Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts</title><title>Clinical medicine insights. Psychiatry</title><description>Introduction:
Atypical antipsychotics are frequently initiated in the intensive care unit (ICU) to treat delirium. Many patients continue on these agents at hospital discharge despite a lack of data to support long-term use.
Objectives:
The primary aim of this study was to determine underlying risk factors for continuation of antipsychotics at hospital discharge in medical intensive care unit (MICU) and surgical intensive care unit (SICU) patients when evaluated as separate cohorts.
Methods:
A single-center, retrospective study in patients newly initiated on quetiapine, risperidone, or olanzapine in a 22-bed mixed medical-surgical ICU admitted from January 2017 to July 2018.
Results:
A total of 78 (62.9%) MICU patients and 46 (37.1%) SICU patients met the inclusion criteria during this time frame. A total of 29 MICU patients (37.2%) were prescribed antipsychotics at hospital discharge compared to 25 SICU patients (54.3%), P = .063. The percentage of MICU patients prescribed antipsychotics at hospital discharge was significantly higher in patients ⩾60 years of age (22 [75.9%] vs 26 [53.1%], P = .045), with a history of dementia (5 [17.2%] vs 1 [2%], P = .015), admitted with hemorrhagic stroke (5 [17.2%] vs 2 [4.1%], P = .049), and initiated on risperidone (3 [10.3%] vs 0%, P = .022). The risk of pre-existing dementia remained significant in a multivariate logistic regression that controlled for confounding variables, odds ratio (OR) = 10 (95% confidence interval [CI]: 1.11-90.5, P = .040). The percentage of SICU patients prescribed antipsychotics at discharge was significantly higher in those with severe traumatic brain injury (TBI; 8 [72.7%] vs 0%, P = .004) and initiated on quetiapine (19 [76%] vs 9 [42.9%], P = .022).
Conclusion:
Antipsychotics were commonly continued at hospital discharge in both MICU and SICU patients. Several risk factors for continuation of antipsychotics were identified in these two cohorts. Future efforts assessing the appropriateness of antipsychotics at transitions of care are warranted.</description><subject>Age</subject><subject>Alcohol</subject><subject>Anesthesia</subject><subject>Antipsychotics</subject><subject>Catheters</subject><subject>Delirium</subject><subject>Dementia</subject><subject>Geriatrics</subject><subject>Hospitals</subject><subject>Illnesses</subject><subject>Intensive care</subject><subject>Medical records</subject><subject>Patients</subject><subject>Physical restraints</subject><subject>Psychotropic drugs</subject><subject>Risk factors</subject><subject>Trauma</subject><subject>Traumatic brain injury</subject><subject>Ventilators</subject><issn>1179-5573</issn><issn>1179-5573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kc1LAzEQxYMoWGrvHgOeV_O1TfZYVmsLBUHa85LNZtvUmmyTVOl_3ywVFEEvSXj5zZt5DAC3GN1jzPlDOoo85xQXYkwFphdg0EtZr13-eF-DUQhbhBBGHJGCD8D-1YQ3OJUqOh9g6zwsnY3GHmQ0zkLXwkk8dkbJHZwkvQtHtXHRqABlhDMXOhPT16MJaiP9WkNj4fLTwbmN2gbzoWEpvYYra2Iy3jgfww24auUu6NHXPQSr6dOynGWLl-d5OVlkihBGsxpTLqggXCNCa55CpWxNgwnTlNRpfFZjxmrRoFa1eSEZb1lPFLjmTS4RHYK7s2_n3f6gQ6y27uBtalkRRjAbFwTn_1KU4lwUQtBEoTOlvAvB67bqvHmX_lhhVPUbqH5vIJVk55Ig1_rb9E_-BGttg7Y</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Levine, Alexander R</creator><creator>Lemieux, Steven M</creator><creator>D’Aquino, Daniela</creator><creator>Tenney, Analise</creator><creator>Pisani, Margaret</creator><creator>Ali, Syed</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AYAGU</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0002-8838-1332</orcidid></search><sort><creationdate>20190101</creationdate><title>Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts</title><author>Levine, Alexander R ; Lemieux, Steven M ; D’Aquino, Daniela ; Tenney, Analise ; Pisani, Margaret ; Ali, Syed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2243-b13783827e023b7813986dd124e32b0704b144b8d0fcf59a47f4986d91b7d5a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Alcohol</topic><topic>Anesthesia</topic><topic>Antipsychotics</topic><topic>Catheters</topic><topic>Delirium</topic><topic>Dementia</topic><topic>Geriatrics</topic><topic>Hospitals</topic><topic>Illnesses</topic><topic>Intensive care</topic><topic>Medical records</topic><topic>Patients</topic><topic>Physical restraints</topic><topic>Psychotropic drugs</topic><topic>Risk factors</topic><topic>Trauma</topic><topic>Traumatic brain injury</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Levine, Alexander R</creatorcontrib><creatorcontrib>Lemieux, Steven M</creatorcontrib><creatorcontrib>D’Aquino, Daniela</creatorcontrib><creatorcontrib>Tenney, Analise</creatorcontrib><creatorcontrib>Pisani, Margaret</creatorcontrib><creatorcontrib>Ali, Syed</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Australia & New Zealand Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Clinical medicine insights. Psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Levine, Alexander R</au><au>Lemieux, Steven M</au><au>D’Aquino, Daniela</au><au>Tenney, Analise</au><au>Pisani, Margaret</au><au>Ali, Syed</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts</atitle><jtitle>Clinical medicine insights. Psychiatry</jtitle><date>2019-01-01</date><risdate>2019</risdate><volume>10</volume><issn>1179-5573</issn><eissn>1179-5573</eissn><abstract>Introduction:
Atypical antipsychotics are frequently initiated in the intensive care unit (ICU) to treat delirium. Many patients continue on these agents at hospital discharge despite a lack of data to support long-term use.
Objectives:
The primary aim of this study was to determine underlying risk factors for continuation of antipsychotics at hospital discharge in medical intensive care unit (MICU) and surgical intensive care unit (SICU) patients when evaluated as separate cohorts.
Methods:
A single-center, retrospective study in patients newly initiated on quetiapine, risperidone, or olanzapine in a 22-bed mixed medical-surgical ICU admitted from January 2017 to July 2018.
Results:
A total of 78 (62.9%) MICU patients and 46 (37.1%) SICU patients met the inclusion criteria during this time frame. A total of 29 MICU patients (37.2%) were prescribed antipsychotics at hospital discharge compared to 25 SICU patients (54.3%), P = .063. The percentage of MICU patients prescribed antipsychotics at hospital discharge was significantly higher in patients ⩾60 years of age (22 [75.9%] vs 26 [53.1%], P = .045), with a history of dementia (5 [17.2%] vs 1 [2%], P = .015), admitted with hemorrhagic stroke (5 [17.2%] vs 2 [4.1%], P = .049), and initiated on risperidone (3 [10.3%] vs 0%, P = .022). The risk of pre-existing dementia remained significant in a multivariate logistic regression that controlled for confounding variables, odds ratio (OR) = 10 (95% confidence interval [CI]: 1.11-90.5, P = .040). The percentage of SICU patients prescribed antipsychotics at discharge was significantly higher in those with severe traumatic brain injury (TBI; 8 [72.7%] vs 0%, P = .004) and initiated on quetiapine (19 [76%] vs 9 [42.9%], P = .022).
Conclusion:
Antipsychotics were commonly continued at hospital discharge in both MICU and SICU patients. Several risk factors for continuation of antipsychotics were identified in these two cohorts. Future efforts assessing the appropriateness of antipsychotics at transitions of care are warranted.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><doi>10.1177/1179557319863813</doi><orcidid>https://orcid.org/0000-0002-8838-1332</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Alcohol Anesthesia Antipsychotics Catheters Delirium Dementia Geriatrics Hospitals Illnesses Intensive care Medical records Patients Physical restraints Psychotropic drugs Risk factors Trauma Traumatic brain injury Ventilators |
| title | Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts |
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