A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study
A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study
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DOI：
10.1186/s12913-018-3345-x
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发表时间：
2018-07-13
影响因子：
2.8
通讯作者：
Rudiger, Alain
中科院分区：
文献类型：
--
作者：
Schubert, Maria;Schurch, Roger;Rudiger, Alain
背景：妄想是心脏手术和重症监护病房(ICU)患者常见的并发症。然而，在许多其他环境中，其流行率和临床后果还没有得到充分的研究。这项研究的目的是：(1)评估大量不同的急性护理患者中的精神错乱患病率；(2)根据定义的指标对这两组患者进行比较；(3)比较精神错乱患者和非精神错乱患者的住院死亡率、ICU和住院时间、护理时间和每个病例的成本。方法：这项队列研究是在瑞士一所大学医院实施精神错乱管理指南后进行的。剔除年龄<18岁或住院天数<1天的患者后，纳入2014年住院患者29‘278例，根据妄想观察量表(DOS)评分=3和/或重症监护妄想筛查量表(ICDSC)评分=4计算妄想期患病率。在心脏手术、神经外科、创伤、放射治疗和神经科患者中，妄想最常见(36.2-40.5%)。在老年科、内脏外科、整形外科和颅颌面外科患者中也较常见(21.6-28.6%)。在未经调整和调整的模型中，精神错乱患者的住院死亡率显著更高，在ICU和医院停留的时间显著更长，需要显著更多的护理时间，每个病例产生的成本显著更高。在7种最常见的ICD-10诊断中，每个诊断组的精神错乱患者的预后比没有精神错乱的患者更差。结论：结果表明，所有患者组都有很高的精神错乱风险，精神错乱的发生率很高。精神错乱的患者表现出明显更差的临床结果，并产生更高的成本。亚组分析强调，在不同患者组中，精神错乱时期的患病率存在显著差异。由于在放射治疗、内脏外科、整形外科、颅颌面外科和口腔外科等护理中心接受治疗的患者中，精神错乱的发生率很高，因此建议将目前的精神错乱管理重点扩大到这些患者群体。
Background: Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case.Methods: This cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29'278 patients hospitalized in the study hospital in 2014 were included.Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score >= 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores >= 4.Results: Of 10'906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2-40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6-28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group's delirious patients had worse outcomes compared to those with no delirium.Conclusions: The results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups.