Reducing delirium after hip fracture: A randomized trial
Reducing delirium after hip fracture: A randomized trial
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DOI：
10.1046/j.1532-5415.2001.49108.x
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发表时间：
2001-05-01
影响因子：
6.3
通讯作者：
Resnick, NM
中科院分区：
文献类型：
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作者：
Marcantonio, ER;Flacker, JM;Resnick, NM
目的：35% - 65%的髋部骨折修复后患者出现谵妄（或急性神志不清），并与功能恢复不良独立相关。我们在一家学术医院的骨科服务部门进行了一项随机试验，以确定积极的老年病学咨询是否可以减少髋部骨折后的谵妄。设计：前瞻性、随机、盲法。环境：住院学术三级医疗中心。参与者：126例65岁及以上的患者（平均年龄79±8岁，79%为女性）急诊接受髋部骨折手术修复。测量方法：通过与患者和指定代理人的访谈以及在入组时对医疗记录进行详细评估，以确定骨折前的状态。然后，受试者被随机分配到术前或手术24小时内开始的主动老年病学咨询，或“常规护理”。一名老年病专家在住院期间每天进行访问，并根据一份结构化协议提出有针对性的建议。为了确定研究结果，所有受试者在住院期间每天进行盲法访谈，包括简易精神状态检查（MMSE）、谵妄症状访谈（DSI）和纪念谵妄评估量表（MDAS）。谵妄诊断采用混淆评估法（CAM）算法。
OBJECTIVES: Delirium (or acute confusional state) affects 35% to 65% of patients after hip-fracture repair, and has been independently associated with poor functional recovery. We performed a randomized trial in an orthopedic surgery service at an academic hospital to determine whether proactive geriatrics consultation can reduce delirium after hip fracture.DESIGN: Prospective, randomized, blinded.SETTINC: Inpatient academic tertiary medical center.PARTICIPANTS: 126 consenting patients 65 and older (mean age 79 +/- 8 years, 79% women) admitted emergently for surgical repair of hip fracture.MEASUREMENTS: Detailed assessment through interviews with patients and designated proxies and review of: medical records was performed at enrollment to ascertain prefracture status. Subjects were then randomized to proactive geriatrics consultation, which began preoperatively or within 24 hours of surgery, or "usual care." A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol. To ascertain study outcomes, all subjects underwent daily, blinded interviews for the duration of their hospitalization, including the Mini-Mental State Examination (MMSE), the Delirium Symptom Interview (DSI), and the Memorial Delirium Assessment Scale (MDAS). Delirium was diagnosed using the Confusion Assessment Method (CAM) algorithm.