Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department.
Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department.
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DOI：
10.1111/jgs.12692
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发表时间：
2014-03
影响因子：
6.3
通讯作者：
Marcantonio ER
中科院分区：
文献类型：
--
作者：
Kennedy M;Enander RA;Tadiri SP;Wolfe RE;Shapiro NI;Marcantonio ER
谵妄在老年急诊科 (ED) 患者中很常见，且诊断不足。本研究的主要目的是建立 ED 谵妄的风险预测规则。第二个目的是比较神志不清的老年 ED 患者与非神志不清的老年 ED 患者的死亡率和资源利用率。前瞻性观察研究。城市三级护理急诊科。 700 名 65 岁或以上前来急诊室就诊的患者。训练有素的研究助理进行了结构化的精神状态评估和注意力测试，然后使用混乱评估方法确定谵妄状态。我们收集了有关患者人口统计、合并症、药物和急诊病程、住院和重症监护病房 (ICU) 入院、住院时间、住院费用以及 30 天再住院和死亡率的数据。百分之九的老年研究参与者神志不清。使用逻辑回归，我们创建了一个由年龄较大、既往中风或短暂性脑缺血发作、痴呆、疑似感染和急性颅内出血组成的谵妄预测规则，具有良好的预测准确性（AUC = 0.77）。在入院的患者中，患有 ED 谵妄的患者中位住院时间较长（4 天与 2 天），并且更有可能需要入住 ICU（13% 对 6%）并出院到新的长期护理机构（37% 对 9%）。在所有患者中，ED 谵妄与较高的 30 天死亡率（6% 对 1%）和 30 天再入院率（27% 对 13%）相关。我们的风险预测规则可能有助于识别一组应接受谵妄筛查的高风险 ED 患者，但需要外部验证。急诊科中谵妄的识别可以使医生能够实施策略来减少谵妄持续时间并避免急性谵妄患者的不当出院，从而改善患者的治疗结果。
Delirium is common and under-diagnosed in elderly Emergency Department (ED) patients. The primary aim of this study is to create a risk prediction rule for ED delirium. The secondary aim is to compare the mortality rates and resource utilization of delirious versus non-delirious elderly ED patients. Prospective observational study. An urban tertiary care emergency department. 700 patients 65 years of age or older and presenting for ED care. A trained research assistant performed a structured mental status assessment and attention tests, after which delirium was determined using the Confusion Assessment Method. We collected data on patient demographics, comorbidities, medications and ED course, hospital and Intensive Care Unit (ICU) admission, length of stay, hospital charges, and 30-day re-hospitalization and mortality. Nine percent of elderly study participants were delirious. Using logistic regression, we created a delirium prediction rule consisting of older age, prior stroke or transient ischemic attack, dementia, suspected infection and acute intracranial hemorrhage with good predictive accuracy (AUC=0.77). Among admitted patients, those with ED delirium had longer median lengths of stay (4 versus 2 days), and were more likely to require ICU admission (13% versus 6%) and to be discharged to a new long-term care facility (37% versus 9%). Among all patients, ED delirium was associated with higher 30-day mortality (6% vs. 1%) and 30-day readmissions (27% vs. 13%). Our risk prediction rule may help identify a group of high risk ED patients that should undergo screening for delirium, but requires external validation. Identification of delirium in the ED may enable physicians to implement strategies to decrease delirium duration and avoid inappropriate discharge of acutely delirious patients, thereby improving patient outcomes.
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影响因子：
3
作者：
Angles, Erik M.;Robinson, Thomas N.;Moore, Ernest E.
通讯作者：
Moore, Ernest E.
影响因子：
120.7
作者：
FRANCIS, J;MARTIN, D;KAPOOR, WN
通讯作者：
KAPOOR, WN
影响因子：
5.7
作者：
Inouye, SK;Rushing, JT;Pompei, P
通讯作者：
Pompei, P
影响因子：
9
作者：
Böhner, H;Hummel, TC;Schneider, F
通讯作者：
Schneider, F
影响因子：
6.2
作者：
Hustey, FM;Meldon, SW
通讯作者：
Meldon, SW