Association between combative behavior requiring intervention and delirium in hospitalized patients

We hypothesized that delirium contributes to combative behavior requiring intervention in hospitalized patients. Delirium identification would therefore potentially provide an opportunity for prevention and early identification of patients at risk, thereby improving safety for patients and staff.

To determine whether delirium is associated with combative behavior requiring intervention in a general hospital population.

Case control study.

A 336-bed, nonuniversity, teaching hospital serving adults in the Pacific Northwest.

One hundred twenty consecutive hospitalized patients with combative behavior requiring intervention compared to 159 randomly selected inpatient control subjects, all from 2011.

Bivariate statistics were used to compare demographics; diagnoses; presence of delirium, dementia, substance use, other psychiatric diagnosis; medications; hospital length of stay; and discharge disposition. We used stepwise logistic regression to determine the association of combative behavior requiring intervention with delirium after adjustment for covariates.

Delirium preceding the combative behavior was present in 50% (60/120) of patients with combative behavior requiring intervention compared to 16% (26/159) of controls (P < 0.001). Combative-behavior patients were hospitalized longer (9.4 vs 4.5 days, P < 0.001), and were more likely to be discharged to a skilled nursing facility (26%, 31/120) or to leave against medical advice (10%, 12/120, P < 0.001). Delirium was strongly associated with combative behavior requiring intervention, after adjustment (odds ratio: 3.8, 95% confidence interval: 2.0-7.3, P < 0.001).

Delirium is strongly associated with combative behavior requiring intervention, which poses a significant safety risk for patients and staff.