Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.
Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.
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DOI：
10.1093/ageing/afac051
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发表时间：
2022-03-01
期刊：
影响因子：
6.7
通讯作者：
Vardy ERLC
中科院分区：
文献类型：
--
作者：
Anand A;Cheng M;Ibitoye T;Maclullich AMJ;Vardy ERLC
使用大规模常规数据调查谵妄结果的研究很少。我们使用 4’A’s Test (4AT) 谵妄检测工具进行了一项两中心研究，分析谵妄与 30 天死亡率、住院时间和居家时间（入院后一年在家的天数）之间的关系。 4AT 是作为常规护理的一部分进行的。使用针对年龄和性别进行调整的逻辑回归模型，对英国洛锡安 (n = 43,946) 和英国索尔福德 (n = 38,824) 3 年期间急诊入院的 65 岁以上患者的数据进行了分析。洛锡安 (Lothian) 的 4AT 完成率为 77%，索尔福德 (Salford) 为 49%。洛锡安 18% 的患者和索尔福德 25% 的患者出现谵妄 (≥4/12) 的 4AT 评分。在洛锡安，4AT ≥4 的 30 天死亡率比 4AT 0/12 组高 5.5 倍（调整后比值比 (aOR) 5.53，95% 置信区间 [CI] 4.99–6.13），在索尔福德则高 3.4 倍（aOR 3.39，95% CI 2.98–3.87）。与 4AT 0/12 相比，4AT 评分为 1-3/12（表明认知障碍）或 ≥ 4/12 的患者的住院时间延长了一倍多。 4AT ≥4 组 1 岁时的中位在家时间减少了 112 天（Lothian）和 61 天（Salford）（P < 0.001）。实践中大规模使用的 4AT 分数与 30 天死亡率、住院时间和居家时间密切相关。研究结果强调需要更好地理解为什么谵妄与不良结果相关，以及改进谵妄的检测和治疗的需要。
Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 ‘A’s Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission). The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of 3 years were analysed using logistic regression models adjusted for age and sex. 4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99–6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98–3.87). Length of stay was more than double in patients with 4AT scores of 1–3/12 (indicating cognitive impairment) or ≥ 4/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT ≥4 group (P < 0.001). Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.
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影响因子：
2.8
作者：
Hercus, Catherine;Hudaib, Abdul-Rahman
通讯作者：
Hudaib, Abdul-Rahman
影响因子：
3.8
作者：
Evensen S;Hylen Ranhoff A;Lydersen S;Saltvedt I
通讯作者：
Saltvedt I
影响因子：
25.8
作者：
Davis DH;Muniz-Terrera G;Keage HA;Stephan BC;Fleming J;Ince PG;Matthews FE;Cunningham C;Ely EW;MacLullich AM;Brayne C;Epidemiological Clinicopathological Studies in Europe (EClipSE) Collaborative Members
通讯作者：
Epidemiological Clinicopathological Studies in Europe (EClipSE) Collaborative Members
影响因子：
2.6
作者：
LaHue, Sara C;Maselli, Judy;Rogers, Stephanie;Casatta, Julie;Chao, Jessica;Croci, Rhiannon;Gonzales, Ralph;Holt, Brian;Josephson, S Andrew;Lama, Sudha;Lau, Catherine;McCulloch, Charles;Newman, John C;Terrelonge, Mark;Yeager, Jan;Douglas, Vanja C
通讯作者：
Douglas, Vanja C
影响因子：
2.9
作者：
Myles, Paul S.;Shulman, Mark A.;Forbes, Andrew
通讯作者：
Forbes, Andrew