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Association between medication-related needle sticks and delirium in the ICU
Thursday April 24, 2025 12:20pm - 12:35pm EDT
Athena H
Association between medication-related needle sticks and delirium in the ICU
Shelby Wathen, Susan Smith, Abigail Powell, John Carr
St. Joseph’s/Candler Hospital
wathensh@sjchs.org 
 
Background
Delirium is a clinical syndrome that is frequently observed in critically ill adults in the intensive care unit (ICU.) Several risk factors have been identified that contribute to delirium. These risk factors include, but are not limited to; pain, older age, infection, catheters, fever, hypoxia, brain injury, sleep deprivation, and sedatives. One risk factor that has not been well established is the number of subcutaneous injections or point-of-care glucose (POCG) tests a patient receives. The purpose of this study is to determine if there is an association between medication-related needle sticks and delirium in the ICU.
Methods
This was a retrospective, observational analysis that included critically ill adult patients (18 years old) who were admitted to the ICU for 72 hours or more from January 1, 2020 to December 31, 2020. Patients were divided into groups based on those who experienced delirium and those who did not. Patients were excluded if their Richmond Agitation Sedation Scale (RASS) was -4 to -5, if they were admitted with an acute neurological diagnosis, cognitive impairment prior to admission, admission for alcohol withdrawal, or history of dementia. Baseline demographic data, number of subcutaneous injections, number of blood glucose checks, RASS score, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, length of hospital stay (LOS), length of ICU stay, and mortality were collected for each patient. The primary outcome was number of medication-related needle sticks per day in the ICU. Secondary outcomes were to determine the number of delirium-free days, all-cause mortality during the index hospitalization, LOS, and ICU LOS.
Results
A total of 404 patients were included in this study, 92 patients in the delirium group and 312 patients in the non-delirium group. The average number of subcutaneous injections and POCG tests per ICU day was 4.28 and 3.55 (p = <0.001) for the delirium and non-delirium groups, respectively. The average number of delirium-free ICU days was 8.5 in the delirium group and 5 in the non-delirium group (p = <0.001). The all-cause mortality rate was 40% in the delirium group and 19% in the non-delirium group (p = <0.001). Average LOS was 16 days and 9 days (p = <0.001) in the delirium and non-delirium groups, respectively  and average ICU LOS was 10 days and 5 days in the delirium and non-delirium groups, respectively (p = <0.001).
Conclusions
There was a statistically significant difference between medication-related needle sticks per day in the delirium group vs the non-delirium group. All-cause mortality rate, number of delirium-free days, average LOS, and average ICU LOS also had a statistically significant difference. More data in a larger, prospective trial is needed to determine if there is a true correlation between needle sticks and delirium.
Moderators
avatar for Dustin Bryan

Dustin Bryan

PGY1 Pharmacy Residency Director, Cape Fear Valley Medical Center
I am a pharmacist from eastern North Carolina. I graduated from Campbell University Pharmacy School in 2012 and completed a PGY1 residency at Cape Fear Valley Medical Center. I have multiple years of hospital experience and my clinical interests include cardiology, intensive care... Read More →
Presenters
avatar for Shelby Wathen

Shelby Wathen

PGY2 Critical Care Resident, St. Joseph's Candler Health System
Dr. Shelby Wathen is originally from Owensboro, KY. She earned her Bachelor’s Degree in Chemistry from Western Kentucky University in Bowling Green, KY before earning her Doctor of Pharmacy degree from Samford University McWhorter School of Pharmacy in Birmingham, AL. Dr. Wathen’s... Read More →
Evaluators
JJ
Thursday April 24, 2025 12:20pm - 12:35pm EDT
Athena H
  Critical Care/Emergency Medicine (CCM), St. Joseph's/Candler Health System
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