The relationship between a chief complaint of "altered mental status" and delirium in older emergency department patients.
The relationship between a chief complaint of "altered mental status" and delirium in older emergency department patients.
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DOI：
10.1111/acem.12436
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Ely EW
中科院分区：
文献类型：
--
作者：
Han JH;Schnelle JF;Ely EW
精神状态改变是老年急诊科（ED）患者常见的主诉。这种主诉的患者可能神志不清，但据作者所知，这种关系还没有很好地表征。此外，卫生保健提供者经常将“精神状态改变”归因于其他原因，如痴呆、精神病或抑郁症。目的是确定“精神状态改变”作为主诉与老年ED患者谵妄之间的关系。这是对一项横断面研究的二次分析，该研究旨在验证2009年7月至2012年3月进行的三次简短谵妄评估。65岁或以上且在急诊科住院时间<12小时的英语患者被纳入研究。昏迷或终末期痴呆患者被排除在外。主诉从急诊科护士分诊评估中获得。谵妄的参考标准是使用精神疾病诊断与统计手册第四版文本修订标准的综合精神病学家评估。敏感度、特异性、阳性似然比和阴性似然比及其95%可信区间（CI）以精神科医生的评估为参考标准计算。共有406名患者入组。中位年龄73.5岁（四分位数范围：69 ~ 80岁），女性202例（50%），非白种人57例（14%），谵妄患者50例（12%）。23人（5.7%）的主诉为精神状态改变。主诉的敏感性为38.0% (95% CI = 25.9% ~ 51.9%)，特异性为98.9% （95% CI = 97.2% ~ 99.6%）。阴性似然比为0.63 (95% CI = 0.50 ~ 0.78)，阳性似然比为33.82 （95% CI = 11.99 ~ 95.38）。没有精神状态改变的主诉不能使临床医生确信没有谵妄。这种综合征将被遗漏，除非它是积极寻找使用有效的谵妄评估。然而，以这种主诉为主诉的患者极有可能神志不清，不需要额外的神志不清评估。
Altered mental status is a common chief complaint among older emergency department (ED) patients. Patients with this chief complaint are likely delirious, but to the authors’ knowledge, this relationship has not been well characterized. Additionally, health care providers frequently ascribe “altered mental status” to other causes, such as dementia, psychosis, or depression. The objective was to determine the relationship between “altered mental status” as a chief complaint and delirium in older ED patients. This was a secondary analysis of a cross-sectional study designed to validate three brief delirium assessments, conducted from July 2009 to March 2012. English-speaking patients who were 65 years or older and in the ED for <12 hours were included. Patients who were comatose or had end-stage dementia were excluded. Chief complaints were obtained from the ED nurse triage assessment. The reference standard for delirium was a comprehensive psychiatrist assessment using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with their 95% confidence intervals (CI) were calculated using the psychiatrist’s assessment as the reference standard. A total of 406 patients were enrolled. The median age was 73.5 years old (interquartile range: 69 to 80 years), 202 (50%) were female, 57 (14%) were non-white race, and 50 (12%) had delirium. Twenty-three (5.7%) of the cohort had chief complaints of altered mental status. The presence of this chief complaint was 38.0% sensitive (95% CI = 25.9% to 51.9%) and 98.9% specific (95% CI = 97.2% to 99.6%). The negative likelihood ratio was 0.63 (95% CI = 0.50 to 0.78), and the positive likelihood ratio was 33.82 (95% CI = 11.99 to 95.38). The absence of a chief complaint of altered mental status should not reassure the clinician that delirium is absent. This syndrome will be missed unless it is actively looked for using a validated delirium assessment. However, patients with this chief complaint are highly likely to be delirious, and no additional delirium assessment is necessary.
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DOI：
10.1111/j.1532-5415.2005.53120.x
发表时间：
2005-02-01
影响因子：
6.3
作者：
Inouye, SK;Leo-Summers, L;Agostini, JV
通讯作者：
Agostini, JV
影响因子：
1.1
作者：
Reeves, Roy R.;Parker, Jefferson D.;Hart, Roy H.
通讯作者：
Hart, Roy H.
影响因子：
6.2
作者：
Han, Jin H.;Shintani, Ayumi;Eden, Svetlana;Morandi, Alessandro;Solberg, Laurence M.;Schnelle, John;Dittus, Robert S.;Storrow, Alan B.;Ely, E. Wesley
通讯作者：
Ely, E. Wesley
影响因子：
6.2
作者：
Han, Jin H.;Bryce, Suzanne N.;Ely, Wesley;Kripalani, Sunil;Morandi, Alessandro;Shintani, Ayumi;Jackson, James C.;Storrow, Alan B.;Dittus, Robert S.;Schnelle, John
通讯作者：
Schnelle, John
影响因子：
39.2
作者：
INOUYE, SK;VANDYCK, CH;HORWITZ, RI
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HORWITZ, RI