Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study.
Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study.
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DOI：
10.2196/43185
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发表时间：
2023-11-30
期刊：
影响因子：
4.9
通讯作者：
Bjarnadottir, Ragnhildur, I
中科院分区：
文献类型：
--
作者：
Solberg, Laurence M.;Duckworth, Laurie J.;Dunn, Elizabeth M.;Dickinson, Theresa;Magoc, Tanja;Snigurska, Urszula A.;Ser, Sarah E.;Celso, Brian;Bailey, Meghan;Bowen, Courtney;Radhakrishnan, Nila;Patel, Chirag R.;Lucero, Robert;Bjarnadottir, Ragnhildur, I
关键词：
据报道，10%至50%的COVID-19患者会出现谵妄，这是一种以注意力不集中为重点的急性精神错乱状态。已注意到因COVID-19住院的患者出现或发展为谵妄和神经认知障碍。谵妄患者的护理给护士、临床医生和护理人员带来了更大的负担。使用电子健康记录数据中的信息来识别谵妄和可能的COVID-19可能导致早期治疗潜在的病毒感染，并改善临床和卫生保健系统的结果，降低每位患者的成本。临床数据存储库可以通过队列识别工具进一步支持快速发现，例如整合生物学信息学和床边工具。本研究的具体目的是调查住院老年人谵妄作为COVID-19可能的表现症状，使用数据库识别一组新的国际疾病分类第十版（ICD-10）代码的神经认知障碍。我们分析了来自2个不同人口统计的集水区的数据。第一个集水区（佛罗里达州中北部的7个县）主要是农村，而第二个集水区（佛罗里达州北部的1个县）主要是城市。对2020年4月1日和2022年4月1日通过卫生中心急诊科（ED）住院的COVID-19患者进行整合生物学和床边数据存储库查询。通过COVID-19实验室检测阳性或诊断代码为U07.1确定患者为COVID-19。我们使用ICD-10代码将神经认知障碍确定为谵妄或脑病。不到三分之一（1437/4828,29.8%）的COVID-19患者被诊断为并发神经认知障碍。在所有经急诊科就诊的新冠肺炎患者中，15.8%（762/4828）在入院时存在神经认知障碍。在合并新冠肺炎和神经认知障碍的患者中，56.9%（817/1437）年龄≥65岁，显著高于无神经认知障碍的患者（P< 0.001）。仅诊断为脑病的患者中年龄<65岁的比例明显高于仅诊断为谵妄和谵妄合并脑病的患者（P< 0.001）。在我们的研究期间，大多数（1272/4828,26.3%）通过急诊科入院的COVID-19患者在Delta变异高峰期间入院。收集的数据表明，入院时出现神经认知障碍的老年患者感染COVID-19的人数有所增加。如前所述，谵妄会增加人员配备、护理需求、使用的医院资源和住院时间，因此在规划新预期的COVID-19激增时，早期识别谵妄可能有利于医院管理。一个健壮且可访问的数据存储库，如本研究中使用的数据存储库，可以为临床医生和临床管理者提供宝贵的资源再分配和临床决策支持。
Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10% to 50% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. Less than one-third (1437/4828, 29.8%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9% (817/1437) were aged ≥65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making.
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影响因子：
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