Abstract
AimThis study aimed to identify the association between total visitation restriction because of the coronavirus 2019 (COVID-19) pandemic and the incidence of delirium for emergency inpatients.MethodsThis was a single-center, retrospective, observational cohort study conducted at a tertiary critical care center in urban Kyoto, Japan. Adult emergency patients hospitalized between January 1, 2019, and June 30, 2020, were recruited. In response to the COVID-19 pandemic, the authors’ hospital began restricted visitation on March 28, 2020. This study defined before visitation restriction as January 1, 2019, through March 31, 2020, and after visitation restriction as April 1, 2020, through June 30, 2020. We did not restrict emergency services, and there were no changes in the hospital’s routine, except for visitation restrictions. The primary outcome was the incidence of delirium. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for delirium incidence was calculated to compare the before and after visitation restriction periods, and the logistic model was used to adjust for seven variables: age, sex, ward type on admission, primary diagnosis, ventilator management, general anesthesia surgery, and dementia.ResultsStudy participants were 6264 patients, median age 74 years (56–83), and 3303 men (52.7%). The total delirium incidence in entire research period was 2.5% (158 of 6264 patients), comprising 1.8% (95/5251) before visitation restriction and 6.2% (63/1013) after visitation restriction. The AOR for delirium incidence was 3.79 (95% CI, 2.70–5.31) after visitation restriction versus before visitation restriction. Subgroup analysis showed no apparent interaction for delirium incidence.ConclusionVisitation restriction was associated with an increased incidence of delirium in emergency inpatients.
Highlights
The incidence of coronavirus disease (COVID-19) infections continues to increase worldwide
In Japan, a national state of emergency was declared on April 16, 2020, which was lifted on May 25, 2020, once the incidence was thought to have declined to a targeted plateau; the number of infections is again increasing
Critical care medical centers are certified by the Japanese Ministry of Health, Labour and Welfare; can accept emergency and severely ill patients transported by ambulance, including cardiac arrest, trauma, stroke, and sepsis patients; and can provide the specialized treatment in an intensive care unit, stroke care unit, and high care unit
Summary
The incidence of coronavirus disease (COVID-19) infections continues to increase worldwide. Prevention of transmission of the COVID-19 infection within the hospital setting is important to maintain the function of the hospital, and various measures have been adopted to meet this goal. Many hospitals have restricted visits to inpatients by their family members and close contacts. The hypothesis in this study is that visitation restrictions to inpatients may increase their risk of delirium. Visitations between patients and their families are important to prevent the delirium [15, 16]
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