Risk factors for delirium at discharge - Development and validation of a predictive model
Risk factors for delirium at discharge - Development and validation of a predictive model
复制标题
DOI：
10.1001/archinte.167.13.1406
复制
发表时间：
2007-07-09
影响因子：
--
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Inouye, Sharon K.;Zhang, Ying;Marcantonio, Edward R.
背景：出院时持续性谵妄与不良预后相关。本研究的目的是开发和验证出院时持续性谵妄的预测模型。方法：本研究遵循前瞻性验证设计。对于开发队列，从学术教学医院的普通医疗单位连续招募了 491 名 70 岁或以上入院且无谵妄并存活出院的患者。对于验证队列，招募了 461 名可比受试者。检查了 22 个候选危险因素，包括 12 个基线因素（入院时存在）和 10 个诱发因素（与医院相关）。主要结局是出院时谵妄，通过混乱评估方法进行测量。结果：开发队列中有 58 名患者 (11.8%) 出院时出现谵妄。出院时出现谵妄的五个独立危险因素被确定：痴呆（比值比 [OR]，2.3；95% 置信区间 [CI]，1.4-3.7）；视力障碍（OR，2.1；95% CI，1.3-3.2）；功能障碍（OR，1.7；95% CI，1.2-3.0）；高合并症（OR，1.7；95% CI，1.1-2.6）；以及在谵妄期间使用身体约束（OR，3.2；95% CI，1.9-5.2）。通过为每个存在的因素加 1 分来创建风险分层系统。低风险（0-1 个因素）、中风险（2-3 个因素）和高风险（4-5 个因素）组的谵妄发生率分别为 4%、18% 和 63% (P < .001)。验证队列中有 28 名患者 (6.1%) 出院时出现谵妄，相应的发生率分别为 3%、14% 和 27% (P < .001)。结论：基于 5 个危险因素的预测模型已成功验证，可用于预测住院老年患者出院时的谵妄。这些风险因素中至少有 4 个适合采取干预策略。
Background: Persistent delirium at the time of hospital discharge is associated with poor outcomes. The objectives of this study were to develop and validate a predictive model for persistent delirium at hospital discharge.Methods: This study followed a prospective validation design. For the development cohort, 491 consecutive patients 70 years or older admitted to the hospital without delirium and surviving to discharge were enrolled from the general medical units of an academic teaching hospital. For the validation cohort, 461 comparable subjects were enrolled. Twenty-two candidate risk factors were examined, including 12 baseline factors (present on admission) and 10 precipitating factors (hospital related). The primary outcome was delirium at hospital discharge, measured by the Confusion Assessment Method.Results: Delirium at discharge was present in 58 patients (11.8%) in the development cohort. Five independent risk factors for delirium at discharge were identified: dementia (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4-3.7); vision impairment (OR, 2.1; 95% CI, 1.3-3.2); functional impairment (OR, 1.7; 95% CI, 1.2-3.0); high comorbidity (OR, 1.7; 95% CI, 1.1-2.6); and use of physical restraints during delirium (OR, 3.2; 95% CI, 1.9-5.2). A risk stratification system was created by adding 1 point for each factor present. Rates of delirium for the low-risk (0-1 factors), intermediate-risk (2-3 factors), and high-risk (4-5 factors) groups were 4%, 18%, and 63%, respectively (P < .001). The corresponding rates in the validation cohort, where 28 patients (6.1%) had delirium at discharge, were 3%, 14%, and 27% (P < .001).Conclusions: A predictive model based on 5 risk factors has been successfully validated for prediction of delirium at discharge in hospitalized older patients. At least 4 of these risk factors are amenable to intervention strategies.