A PREDICTIVE MODEL FOR DELIRIUM IN HOSPITALIZED ELDERLY MEDICAL PATIENTS BASED ON ADMISSION CHARACTERISTICS
A PREDICTIVE MODEL FOR DELIRIUM IN HOSPITALIZED ELDERLY MEDICAL PATIENTS BASED ON ADMISSION CHARACTERISTICS
复制标题
DOI：
10.7326/0003-4819-119-6-199309150-00005
复制
发表时间：
1993-09-15
影响因子：
39.2
通讯作者：
TINETTI, ME
中科院分区：
文献类型：
--
作者：
INOUYE, SK;VISCOLI, CM;TINETTI, ME
目的：为了前瞻性地开发和验证一个预测模型的发生新的谵妄在住院老年内科patients的基础上的特点，目前在admission.Design：两个前瞻性队列研究做串联。设置：大学教学hospital.Patients：发展队列包括107住院普通内科患者70岁或以上，入院时没有痴呆或谵妄。验证队列包括174可比patients.Measurements：患者进行评估，每天谵妄使用标准化的，有效的工具。然后在另一组患者中验证了初始队列中开发的预测模型。结果：开发队列中107名患者中有27名（25%）出现谵妄。使用比例风险分析确定了谵妄的四个独立基线风险因素：（校正的相对风险，3.5; 95% CI，1.2 - 10.7）;严重疾病（相对危险度，3.5; CI，1.5 - 8.2）;认知障碍（相对危险度，2.8; CI，1.2至6.7）;和高血尿素氮/肌酐比值（相对危险度，2.0; CI，0.9至4.6）。通过为存在的每个风险因素分配1分来开发风险分层系统。低危组（0分）、中危组（1 ~ 2分）和高危组（3 ~ 4分）的谵妄发生率分别为9%、23%和83%（P < 0.0001）。在验证队列中，174例患者中有29例（17%）发生谵妄，相应的发生率分别为3%、16%和32%（P < 0.002）。死亡率或养老院安置率，可能与谵妄相关的结局，分别为9%、16%和42%。（P = 0.02），分别为3%、14%和26%（P = 0.007）。结论：老年住院患者中谵妄很常见，而一个基于四个风险因素的简单预测模型可以在入院时使用，以确定风险最大的老年人。
Objective: To prospectively develop and validate a predictive model for the occurrence of new delirium in hospitalized elderly medical patients based on characteristics present at admission.Design: Two prospective cohort studies done in tandem.Setting: University teaching hospital.Patients: The development cohort included 107 hospitalized general medical patients 70 years or older who did not have dementia or delirium at admission. The validation cohort included 174 comparable patients.Measurements: Patients were assessed daily for delirium using a standardized, validated instrument. The predictive model developed in the initial cohort was then validated in a separate cohort of patients.Results: Delirium developed in 27 of 107 patients (25%) in the development cohort. Four independent baseline risk factors for delirium were identified using proportional hazards analysis: These included vision impairment (adjusted relative risk, 3.5; 95% CI, 1.2 to 10.7); severe illness (relative risk, 3.5; CI, 1.5 to 8.2); cognitive impairment (relative risk, 2.8; CI, 1.2 to 6.7); and a high blood urea nitrogen/creatinine ratio (relative risk, 2.0; CI, 0.9 to 4.6). A risk stratification system was developed by assigning 1 point for each risk factor present. Rates of delirium for low- (0 points), intermediate-(1 to 2 points), and high-risk (3 to 4 points) groups were 9%, 23%, and 83% (P < 0.0001), respectively. The corresponding rates in the validation cohort, in which 29 of 174 patients (17%) developed delirium, were 3%, 16%, and 32% (P < 0.002). The rates of death or nursing home placement, outcomes potentially related to delirium, were 9%, 16%, and 42% (P = 0.02) in the development cohort and 3%, 14%, and 26% (P = 0.007) in the validation cohort.Conclusions: Delirium among elderly hospitalized patients is common, and a simple predictive model based on four risk factors can be used at admission to identify elderly persons at the greatest risk.