Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients
Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients
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DOI：
10.1111/jgs.14103
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发表时间：
2016-05-01
影响因子：
6.3
通讯作者：
Bellelli, Giuseppe
中科院分区：
文献类型：
--
作者：
Bo, Mario;Bonetto, Martina;Bellelli, Giuseppe
目的确定急诊科（艾德）入院前住院时间是否与老年人谵妄事件有关。设计前瞻性队列研究。设置医院。患者年龄75岁及以上，在艾德入院时无谵妄、昏迷、失语、卒中、语言障碍、精神障碍或酒精滥用的患者（N=330）。测量艾德入院时，个体接受标准化的合并症评估（累积疾病评定量表），认知障碍（简易精神状态问卷），功能独立性（日常生活活动、日常生活工具活动）、疼痛（数字评定量表）和急性临床状况（急性生理学和慢性健康评估II）。在入院后的前30天内，每天使用谵妄快速评估（4AT量表）评估谵妄（定义为72小时内1次谵妄发作）的存在。艾德住院时间计算为从艾德登记到离开艾德的时间（小时）。结果艾德住院时间超过10小时（比值比（OR）=2.23，95%置信区间（CI）=1.13-4.41），中度至重度认知障碍（OR=5.47，95%CI =2.76-10.85）和年龄较大（OR=1.07，95%CI =1.01-1.13）与谵妄发作有关。
ObjectivesTo determine whether emergency department (ED) length of stay before ward admission is associated with incident delirium in older adults.DesignProspective cohort study.SettingHospital.ParticipantsIndividuals aged 75 and older without delirium at ED entry, coma, aphasia, stroke, language barrier, psychiatric disorder, or alcohol abuse (N=330).MeasurementsOn ED admission, individuals underwent standardized evaluation of comorbidity (Cumulative Illness Rating Scale), cognitive impairment (Short Portable Mental Status Questionnaire), functional independence (activities of daily living, instrumental activities of daily living), pain (Numeric Rating Scale), and acute clinical conditions (Acute Physiology and Chronic Health Evaluation II). During the first 3days after ward admission, the presence of delirium (defined as 1 delirium episodes within 72hours) was assessed daily using a rapid assessment for delirium (4AT scale). ED length of stay was calculated as the time (hours) between ED registration and when the person left the ED.ResultsED length of stay longer than 10hours (odds ratio (OR)=2.23, 95% confidence interval (CI)=1.13-4.41), moderate to severe cognitive impairment (OR=5.47, 95% CI=2.76-10.85), and older age (OR=1.07, 95% CI=1.01-1.13) were associated with delirium onset.ConclusionED length of stay longer than 10hours was associated with greater risk of delirium in hospitalized older adults, after adjusting for age and cognitive impairment.