The prevalence and documentation of impaired mental status in elderly emergency department patients
The prevalence and documentation of impaired mental status in elderly emergency department patients
复制标题
DOI：
10.1067/mem.2002.122057
复制
发表时间：
2002-03-01
影响因子：
6.2
通讯作者：
Meldon, SW
中科院分区：
文献类型：
--
作者：
Hustey, FM;Meldon, SW
研究目的：我们试图确定老年急诊科患者的精神状态损害的患病率，并评估文件和转诊急诊医生出院后的精神状态损害的艾德.Methods：我们进行了一项前瞻性，观察性研究的方便样本297例70岁或以上的城市教学医院艾德超过12个月的时间。采用定向-记忆-注意力检查对患者进行认知障碍筛查，采用意识模糊评估法对患者进行谵妄筛查。文件，处置，并转介图表review.Results：二百九十七个337名合格的患者被录取。297人中的78人（26%; 95%置信区间[Cl] 21%至31%）患者有精神状态损害; 30（10%; 95% CI 7%至14%）出现谵妄; 48（16%; 95% CI 12%-20%）有认知障碍，无谵妄; 17例（6%; 95% CI 3%-9%）两项检查均为阳性。78例患者中只有22例（28%; 95%CI 19%-40%）急诊医生记录了精神状态损害。13例患者（17%; 95%CI 9%-27%）特别提到谵妄、认知障碍或可接受的同义词。在34个国家（44%; 95% CI 32%-55%）精神状态受损患者出院回家，只有6例（18%; 95% CI 7%-35%）有急诊医生记录的解决受损的计划。30例谵妄患者中有11例（37%; 95%CI 20%至56%）出院回家。十六（70%;出院回家的23名认知功能障碍患者中，95% CI 47%至87%）既往无痴呆病史;这些患者获得专业护理援助的可能性（13%; 95% CI 4%至27%）低于已知痴呆患者（58%; 95% CI 28%至85%）。精神状态受损在老年艾德患者中很常见。缺乏文件，入院，或急诊医生转介表明缺乏认识这一重要问题。
Study objective: We sought to determine the prevalence of mental status impairment in elderly emergency department patients and to assess documentation of and referrals by emergency physicians for mental status impairment after discharge from the ED.Methods: We performed a prospective, observational study of a convenience sample of 297 patients 70 years or older presenting to an urban teaching hospital ED over a 12-month period. Patients were screened with the Orientation-Memory-Concentration examination for cognitive impairment and the Confusion Assessment Method for delirium. Documentation, dispositions, and referrals were abstracted from chart review.Results: Two hundred ninety-seven of the 337 eligible patients were enrolled. Seventy-eight of the 297 (26%; 95% confidence interval [Cl] 21 % to 31 %) patients had mental status impairment; 30 (10%; 95% Cl 7% to 14%) had delirium; 48 (16%; 95% Cl 12% to 20%) had cognitive impairment without delirium; 17 (6%; 95% Cl 3% to 9%) screened positive on both examinations. Only 22 (28%; 95% Cl 19% to 40%) of the 78 patients had any documentation of mental status impairment by the emergency physician. Specific mention of delirium, cognitive impairment, or an acceptable synonym was noted in 13 (17%; 95% Cl 9% to 27%). Of 34 (44%; 95% Cl 32% to 55%) patients with mental status impairment discharged home, only 6 (18%; 95% Cl 7% to 35%) had plans documented by the emergency physician to address impairment. Eleven (37%; 95% Cl 20% to 56%) of the 30 patients with delirium were discharged home. Sixteen (70%; 95% Cl 47% to 87%) of the 23 patients with cognitive impairment who were discharged home had no prior history of dementia; these patients were less likely to have specialized assistance with care (13%; 95% Cl 4% to 27%) than those with known dementia (58%; 95% Cl 28% to 85%).Conclusion: Impaired mental status is common among older ED patients. Lack of documentation, admission, or referral by emergency physicians suggests a lack of recognition of this important problem.