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Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR et al.. JAMA, 2004-04-01
Topic: Risk, prevention and care in population studies
Context In the intensive care unit (ICU), delirium is a common yet underdiagnosed form of organ dysfunction, and its contribution to patient outcomes is unclear. Objective To determine if delirium is an independent predictor of clinical outcomes, including 6-month mortality and length of stay among ICU patients receiving mechanical ventilation. Design, setting, and participants Prospective cohort study enrolling 275 consecutive mechanically ventilated patients admitted to adult medical and coronary ICUs of a US university-based medical center between February 2000 and May 2001. Patients were followed up for development of delirium over 2158 ICU days using the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale. Main outcome measures Primary outcomes included 6-month mortality, overall hospital length of stay, and length of stay in the post-ICU period. Secondary outcomes were ventilator-free days and cognitive impairment at hospital discharge. Results Of 275 patients, 51 (18.5%) had persistent coma and died in the hospital. Among the remaining 224 patients, 183 (81.7%) developed delirium at some point during the ICU stay. Baseline demographics including age, comorbidity scores, dementia scores, activities of daily living, severity of illness, and admission diagnoses were similar between those with and without delirium (P>.05 for all). Patients who developed delirium had higher 6-month mortality rates (34% vs 15%, P =.03) and spent 10 days longer in the hospital than those who never developed delirium (P Conclusion Delirium was an independent predictor of higher 6-month mortality and longer hospital stay even after adjusting for relevant covariates including coma, sedatives, and analgesics in patients receiving mechanical ventilation.
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APA 7th
Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell, F. E., et al. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. https://doi.org/10.1001/jama.291.14.1753
Vancouver
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004. doi:10.1001/jama.291.14.1753. PMID: 15082703.
BibTeX
@article{ely2004-15082703,
author = {Ely, E. W. and Shintani, A. and Truman, B. and Speroff, T. and Gordon, S. M. and Harrell, F. E. and Inouye, S. K. and Bernard, G. R. and others},
title = {{Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit}},
journal = {JAMA},
year = {2004},
doi = {10.1001/jama.291.14.1753},
pmid = {15082703},
url = {https://doi.org/10.1001/jama.291.14.1753}
}
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Key findings
- Main outcome measures Primary outcomes included 6-month mortality, overall hospital length of stay, and length of stay in the post-ICU period.
- Results Of 275 patients, 51 (18.5%) had persistent coma and died in the hospital.
Why it matters
In 275 ventilated ICU patients at one US hospital, 81.7% of those who could be assessed developed delirium, and they had higher 6-month mortality than those who did not (34% vs 15%) and stayed in hospital 10 days longer. The authors found delirium was an independent predictor of death and longer stay after adjusting for coma, sedatives and painkillers. This is an association in critically ill patients, not a test of any treatment, and it does not study Alzheimer's disease.
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Study details
- Study designcohort study
- Participants275
- Effect size18.5%; 81.7%
- Evidence strengthModerate
How this study scored 74/100
Published in a top-tier journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2004 — older than 20 years, still counted |
| Sample size | 2 / 4 | 275 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 3,072 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 128.0 citations a year over 24 year(s) since 2004 |
| Impact for its field and year | 6 / 6 | Cited 48.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 15 other studies in this library |
| Still being cited | 4 / 4 | Cited 367 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Eugene Wesley Ely: h-index 135 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | VA Tennessee Valley Healthcare System: institution h-index 317 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 15082703) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 74 / 100 | — |
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Read the original
- DOI: 10.1001/jama.291.14.1753
- PubMed: 15082703
- Original source →
- Free full text: Digital Access to Scholarship at Harvard (DASH) (Harvard University) →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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