The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome
The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome
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DOI：
10.3390/geriatrics4040057
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发表时间：
2019-12-01
期刊：
影响因子：
2.3
通讯作者：
Moug, Susan J.
中科院分区：
文献类型：
--
作者：
Hewitt, Jonathan;Owen, Stephanie;Moug, Susan J.
背景：随着人口老龄化，越来越多的老年人被送往急性外科病房进行评估。老年人有可能影响结果的特定因素，其中之一是谵妄（急性认知障碍）。目的：确定老年急性手术患者入院时谵妄的患病率及其对死亡率的影响。研究的次要结局包括再入院和住院时间。方法：这项观察性多中心研究调查了连续患者，>= 65岁，在8周内入住英国5家医院的急性外科病房。入院时，进行意识模糊评估方法（CAM）评分以检测谵妄。使用关联和逻辑回归模型检验来研究谵妄对重要临床结果的影响。结果：该队列包括411例患者，平均年龄为77.3岁（SD 8.1）。入院谵妄的患病率为8.8%（95% CI 6.2-11.9%），认知功能障碍的患病率为70.3%（95% CI 65.6-74.7%）。谵妄组在30或90天时死亡的可能性并不高（OR 1.1，95% CI 0.2至5.1，p = 0.67; OR 1.4，95% CI 0.4至4.1）。p = 0.82）或出院后30天内再次入院（OR 0.9，95% CI 0.4 - 2.2，p = 0.89）。谵妄组的住院时间明显更长（中位数分别为8天和5天，p = 0.009）。结论：入院谵妄发生在不到10%的老年人承认急性外科单位，导致显着更长的住院时间。
Background: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). Objectives: To establish the prevalence of delirium on admission in an older acute surgical population and its effect on mortality. Secondary outcomes investigated include hospital readmission and length of hospital stay. Method: This observational multi-centre study investigated consecutive patients, >= 65 years, admitted to the acute surgical units of five UK hospitals during an eight-week period. On admission the Confusion Assessment Method (CAM) score was performed to detect delirium. The effect of delirium on important clinical outcomes was investigated using tests of association and logistic regression models. Results: The cohort consisted of 411 patients with a mean age of 77.3 years (SD 8.1). The prevalence of admission delirium was 8.8% (95% CI 6.2-11.9%) and cognitive impairment was 70.3% (95% CI 65.6-74.7%). The delirious group were not more likely to die at 30 or 90 days (OR 1.1, 95% CI 0.2 to 5.1, p = 0.67; OR 1.4, 95% CI 0.4 to 4.1. p = 0.82) or to be readmitted within 30 days of discharge (OR 0.9, 95% CI 0.4 to 2.2, p = 0.89). Length of hospital stay was significantly longer in the delirious group (median 8 vs. 5 days respectively, p = 0.009). Conclusion: Admission delirium occurs in just under 10% of older people admitted to acute surgical units, resulting in significantly longer hospital stays.