A CLINICAL-PREDICTION RULE FOR DELIRIUM AFTER ELECTIVE NONCARDIAC SURGERY
A CLINICAL-PREDICTION RULE FOR DELIRIUM AFTER ELECTIVE NONCARDIAC SURGERY
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DOI：
10.1001/jama.271.2.134
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发表时间：
1994-01-12
影响因子：
120.7
通讯作者：
LEE, TH
中科院分区：
文献类型：
--
作者：
MARCANTONIO, ER;GOLDMAN, L;LEE, TH
客观。-使用临床医生术前可用的数据，开发并验证术后谵妄的临床预测规则。前瞻性队列研究。设置。-马萨诸塞州波士顿布里格姆妇女医院的普通外科、矫形外科和妇科服务。1990年11月1日至1992年3月15日期间因重大择期非心脏手术而入院的50岁以上患者（N=1341）。所有患者均接受术前评估，包括病史、体格检查、实验室检查以及使用特定活动量表和认知状态电话访谈评估身体和认知功能。术后谵妄的诊断采用混淆评估法或病历资料及医院护理强度指数。随访患者的住院时间，以确定主要并发症发生率，住院时间和出院处置。在研究的1341例患者中，117例（9%）发生术后谵妄。独立相关因素包括年龄70岁或以上;自我报告的酒精滥用;认知状态差;功能状态差;术前血清钠、钾或葡萄糖水平明显异常;非心脏胸外科手术;主动脉瘤手术。使用这七个术前因素，一个简单的预测规则。在独立人群中，该规则将患者分为术后谵妄发生率低（2%）、中（8%，13%）和高（50%）的组。发生谵妄的患者有更高的主要并发症发生率，住院时间更长，出院到长期护理或康复机构的比率更高。利用术前可用的数据，临床医生可以将患者分为发生谵妄的风险组。由于谵妄与各种不良结局相关，因此具有该并发症实质风险的患者可能是干预的候选者，以降低术后谵妄的发生率并可能改善整体手术结局。
Objective.-To develop and validate a clinical prediction rule for postoperative delirium using data available to clinicians preoperatively.Design.-Prospective cohort study.Setting.-General surgery, orthopedic surgery, and gynecology services at Brigham and Women's Hospital, Boston, Mass.Patients.-Consenting patients older than 50 years admitted for major elective noncardiac surgery between November 1, 1990, and March 15, 1992 (N=1341).Measurements.-All patients underwent preoperative evaluations, including a medical history, physical examination, laboratory tests, and assessments of physical and cognitive function using the Specific Activity Scale and the Telephone Interview for Cognitive Status. Postoperative delirium was diagnosed using the Confusion Assessment Method or using data f rom the medical record and the hospital's nursing intensity index. Patients were followed up for the duration of hospitalization to determine major complication rates, length of stay, and discharge disposition.Results.-Postoperative delirium occurred in 117 (9%) of the 1341 patients studied. Independent correlates included age 70 years or older; self-reported alcohol abuse; poor cognitive status; poor functional status; markedly abnormal preoperative serum sodium, potassium or glucose level; noncardiac thoracic surgery; and aortic aneurysm surgery. Using these seven preoperative factors, a simple predictive rule was developed. In an independent population, the rule stratified patients into groups with low (2%), medium (8%, 13%), and high (50%) rates of postoperative delirium. Patients who developed delirium had higher rates of major complications, longer lengths of stay, and higher rates of discharge to long-term care or rehabilitative facilities.Conclusions.- Using data available preoperatively, clinicians can stratify patients into risk groups for the development of delirium. Since delirium is associated with a variety of adverse outcomes, patients with substantial risk for this complication could be candidates for interventions to reduce the incidence of postoperative delirium and potentially improve overall surgical outcomes.