Diagnosing delirium in very elderly intensive care patients
Diagnosing delirium in very elderly intensive care patients
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DOI：
10.1016/j.iccn.2016.07.002
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发表时间：
2017-02-01
影响因子：
5.3
通讯作者：
Sritharan, Gaya
中科院分区：
文献类型：
--
作者：
Heriot, Natalie R.;Levinson, Michele R.;Sritharan, Gaya
目的：确定老年重症监护患者谵妄的发生率，并使用两种基于回顾性图表的诊断方法和医院报告措施（ICD-10）比较其发生率。设计：回顾性研究。设置：澳大利亚墨尔本一家大型大都市私立医院的ICU。患者：讲英语的参与者（n = 348）80岁以上，入住ICU>24小时。测量和主要结果：采用Inouye病历回顾法、DSM-IV诊断标准和ICD-10编码数据对2009年10月至2012年10月入住ICU患者的病历进行谵妄回顾性评估。记录患者的一般特征、首次出现谵妄症状、谵妄信息来源、谵妄药物给药、住院和ICU住院时间、90天死亡率。11-29%的患者出现谵妄，这是通过病历审查确定的最高发病率。诊断为谵妄的患者有较高的90天死亡率，和那些符合标准的所有三种方法有较长的住院时间和ICU的stay.Conclusions：ICU谵妄在老年人往往是报告不足，战略需要提高工作人员的教育和诊断。(C)2016爱思唯尔有限公司版权所有
Objective: To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10).Design: Retrospective study.Setting: An ICU in a large metropolitan private hospital in Melbourne, Australia.Patients: English-speaking participants (n = 348) 80+ years, admitted to ICU for >24 hours.Measurements and main results: Medical files of ICU patients admitted October 2009 October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data. General patient characteristics, first onset of delirium symptoms, source of delirium information, administration of delirium medication, hospital and ICU length of stay, 90 day mortality were documented. Delirium was found in 11-29% of patients, the highest incidence identified by chart review. Patients diagnosed with delirium had higher 90 day mortality, and those meeting criteria for all three methods had longer hospital and ICU length of stay.Conclusions: ICU delirium in the elderly is often under-reported and strategies are needed to improve staff education and diagnosis. (C) 2016 Elsevier Ltd. All rights reserved.