Association between visitation restriction and delirium incidence among emergency trauma inpatients: A single-center retrospective observational cohort study in Japan

Abstract text (incl. references and figure legends)

Introduction: Delirium is associated with many adverse outcomes. Prevention of the development of delirium is important, and family engagement is accordingly incorporated as an "F" component in the ABCDEF bundle. To prevent the coronavirus 2019 (COVID-19) transmission, many hospitals have restricted visits to inpatients by their family members and close contacts. We hypothesized that visitation restrictions to inpatients may increase their risk of delirium. This study aimed to identify the association between total visitation restriction because of the COVID-19 pandemic and the incidence of delirium for trauma inpatients.

Methods: Adult emergency trauma patients hospitalized between January 1, 2019, and June 30, 2020, were recruited. In response to the COVID-19 pandemic, our 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. 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 six variables: age, sex, ward type on admission, ventilator management, general anesthesia surgery, and dementia.

Results: This study analyzed 1,042 patients, with a median age of 73.5 years (57–83) and included 566 men (54.3%). The total delirium incidence in entire research period was 3.9% (41 of 1,042 patients), comprising 3.0% (26/876) before visitation restriction and 9.0% (15/166) after visitation restriction. The AOR for delirium incidence was 4.19 (95% CI,2.09–8.41) after visitation restriction versus before visitation restriction.

Conclusions: Visitation restriction was associated with an increased incidence of delirium in emergency trauma inpatients.

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