Does delirium increase hospital stay?
Does delirium increase hospital stay?
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DOI：
10.1046/j.1532-5415.2003.51509.x
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发表时间：
2003-11-01
影响因子：
6.3
通讯作者：
Belzile, E
中科院分区：
文献类型：
--
作者：
McCusker, J;Cole, MG;Belzile, E
设计：前瞻性队列研究，比较(1)流行性和偶发性妄想性妄想症患者入院后的住院时间与(2)偶发性妄想性妄想症患者与确诊日相匹配的对照组入院后的住院期。住进重症监护室或肿瘤科的患者和那些被初步诊断为中风的患者被排除在外。测量：用迷惑评定法诊断精神错乱。从管理数据中提取住院时间和诊断相关组(DRGs)的数据。协变量包括老年人认知衰退调查问卷、妄想指数、老年美国资源和服务项目日常生活活动能力问卷、查尔森共病指数、临床严重程度量表和急性生理学评分。结果：研究样本包括359例患者：204例普遍精神障碍，37例偶发精神障碍，118例无精神障碍。在控制了协变量后，普遍存在的精神错乱与住院时间的显著延长无关，但偶发的精神错乱与确诊后的多住7.78天有关(95%可信区间=3.07，12.48)。使用对数变换或DRG调整的住院时间估计也得到了类似的结果。结论：在老年内科住院患者中，偶发但不普遍的妄想是较长住院时间的重要预测因素。预防偶发性精神错乱的干预措施可能会减少住院时间。
OBJECTIVE: To determine the effects of prevalent and incident delirium on length of hospital stay.DESIGN: Prospective cohort study, comparing (1) length of stay after admission in cases of prevalent delirium versus controls without prevalent delirium with (2) length of stay after diagnosis in cases of incident delirium versus controls matched by day of diagnosis.SETTING: The medical services of a primary, acute care hospital.PARTICIPANTS: Medical admissions of patients aged 65 and older from the emergency department with delirium diagnosed during the first week in hospital. Patients admitted to intensive care or oncology and those with a primary diagnosis of stroke were excluded. A sample of those without delirium was also enrolled.MEASUREMENTS: Delirium was diagnosed using the Confusion Assessment Method. Data on length of stay and diagnosis-related groups (DRGs) were abstracted from administrative data. Measures of covariates included the Informant Questionnaire on Cognitive Decline in the Elderly, the Delirium Index, the instrumental activities of daily living questionnaire from the Older American Resources and Services project, the Charlson Comorbidity Index, the Clinical Severity Scale, and the Acute Physiology Score.RESULTS: The study sample comprised 359 patients: 204 with prevalent delirium, 37 with incident delirium, and 118 without delirium. After controlling for covariates, prevalent delirium was not associated with a significantly longer hospital stay, but incident delirium was associated with an excess stay after diagnosis of 7.78 days (95% confidence interval=3.07, 12.48). Similar results were obtained using log-transformed or DRG-adjusted estimates of length of stay.CONCLUSION: In older medical inpatients, incident but not prevalent delirium is an important predictor of longer hospital stay. Interventions to prevent incident delirium may reduce length of stay.