The cause of delirium in patients with hip fracture
The cause of delirium in patients with hip fracture
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DOI：
10.1001/archinte.160.12.1856
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发表时间：
2000-06-26
影响因子：
--
通讯作者：
Siu, AL
中科院分区：
文献类型：
--
作者：
Brauer, C;Morrison, RS;Siu, AL
目的：为了确定谵妄的最常见的原因，建立谵妄的开始和时间，并确定谵妄的持续时间在hipfracture.Methods：五百七十一（88%）的650例髋部骨折患者入院4纽约市医院进行了前瞻性的采访，每天的基础上，每周5天，与混乱的评估方法谵妄的存在。患者在入院后48小时内入组。对他们的病历和研究工作人员收集的数据进行了审查和总结。两个人（R.S.M.）和A.I.S.）独立审查病例总结，并根据先前开发的分类系统指定原因，估计谵妄发作的发作，并确定出院时谵妄是否已清除、改善或持续。随后，差异的原因，启动的时间，和出院时的精神状态之间的2个医生的评论进行了讨论，直到consensus was agreed.Results：谵妄的患病率为9.5%（54/ 571; 95%置信区间，7.0-11.9）。7%的发作被指定为明确原因，20%为可能原因，11%为可能原因，61%可归因于1种或多种共病状况。54例受试者中有28例（53%）在手术后发生谵妄。谵妄已清除或改善，在40（74%）的54名受试者在discharge.Conclusions：谵妄髋关节骨折患者似乎是一个不同的综合征，观察到的患者谁是其他医疗疾病，它似乎也遵循不同的临床过程。这些结果对髋部骨折患者谵妄的处理具有重要意义。
Objectives: To ascertain the most common causes of delirium, to establish the initiation and timing of delirium, and to determine the duration of delirium in patients with hip fracture.Methods: Five hundred seventy-one (88%) of 650 patients with hip fracture admitted to 4 New York City hospitals were prospectively interviewed on a daily basis, 5 days a week, with the Confusion Assessment Method for the presence of delirium. The patients were enrolled within 48 hours of admission. Their medical charts and the data collected by the study staff were reviewed and summarized. Two of us (R.S.M. and A.I.S.) reviewed the case summaries independently and assigned a cause based on a previously developed classification system, estimated the onset of the delirious episode, and determined whether the delirium had cleared, improved, or persisted at discharge. Subsequently, discrepancies in cause, timing of initiation, and mental status on discharge between the 2 physicians reviewers were discussed until consensus was reached.Results: The prevalence of delirium was 9.5% (54/ 571; 95% confidence interval, 7.0-11.9). Seven percent of episodes were assigned a definite cause, 20% a probable cause, 11% a possible cause, and 61% were attributable to 1 or more comorbid conditions. Twenty-eight (53%) of 54 subjects developed delirium after surgery. The delirium had cleared or improved in 40 (74%) of 54 subjects at the time of discharge.Conclusions: Delirium in patients with hip fracture appears to be a different syndrome from that observed in patients who are otherwise medically ill; it also appears to follow a different clinical course. These results have important implications for the management of delirium in patients with hip fracture.