Precipitating factors for delirium in hospitalized elderly persons - Predictive model and interrelationship with baseline vulnerability
Precipitating factors for delirium in hospitalized elderly persons - Predictive model and interrelationship with baseline vulnerability
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DOI：
10.1001/jama.275.11.852
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发表时间：
1996-03-20
影响因子：
120.7
通讯作者：
Charpentier, PA
中科院分区：
文献类型：
--
作者：
Inouye, SK;Charpentier, PA
目的：前瞻性地开发和验证基于住院期间诱发因素的妄想预测模型，并检验诱发因素和基线易损性之间的相互关系。设计-两项前瞻性队列研究，设置在普通内科病房、大学教学医院和患者。-在发展队列中，196名年龄在70岁及以上的患者在基线上没有精神错乱，对于验证队列，312名可比较的患者。主要结果衡量。-根据混淆评估方法诊断标准，在住院第9天新发妄想。结果-在发展队列中，35名患者(18%)出现精神错乱。确定了五个独立的诱发因素：使用身体约束(调整后的相对风险[RR]，4.4；95%可信区间[CI]，2.5至7.9)，营养不良(RR，4.0；95%CI，2.2至7.4)，添加三种以上药物(RR，2.9；95%CI，1.6至5.4)，使用膀胱导管(RR，2.4；95%CI，1.2至4.7)，以及任何医源性事件(RR，1.9；95%可信区间，1.1至3.2)。每一种诱发因素都早于精神错乱发作超过24小时。建立了风险分层系统，对存在的每个因素加1分。低危组(0分)、中危组(1~2分)和高危组(大于或等于3分)的妄想率分别为3%、20%和59%(P
Objectives.-To prospectively develop and validate a predictive model for delirium based on precipitating factors during hospitalization, and to examine the interrelationship of precipitating factors and baseline vulnerability.Design.-Two prospective cohort studies, in tandem.Setting.-General medical wards, university teaching hospital.Patients.-For the development cohort, 196 patients aged 70 years and older with no delirium at baseline, and for the validation cohort, 312 comparable patients.Main Outcome Measure.-New-onset delirium by hospital day 9, defined by the Confusion Assessment Method diagnostic criteria.Results.-Delirium developed in 35 patients (18%) in the development cohort. Five independent precipitating factors for delirium were identified: use of physical restraints (adjusted relative risk [RR], 4.4; 95% confidence interval [CI], 2.5 to 7.9), malnutrition (RR, 4.0; 95% CI, 2.2 to 7.4), more than three medications added (RR, 2.9; 95% CI, 1.6 to 5.4), use of bladder catheter (RR, 2.4; 95% CI, 1.2 to 4.7), and any iatrogenic event (RR, 1.9; 95% CI, 1.1 to 3.2). Each precipitating factor preceded the onset of delirium by more than 24 hours. A risk stratification system was developed by adding 1 point for each factor present. Rates of delirium for low-risk (0 points), intermediate-risk (1 to 2 points), and high-risk groups (greater than or equal to 3 points) were 3%, 20%, and 59%, respectively (P