Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study
Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study
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DOI：
10.1046/j.1525-1497.1998.00073.x
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发表时间：
1998-04-01
影响因子：
5.7
通讯作者：
Pompei, P
中科院分区：
文献类型：
--
作者：
Inouye, SK;Rushing, JT;Pompei, P
目的：确定入院谵妄对医院结局的独立贡献，包括死亡率、制度化和功能下降。设计：三项前瞻性队列研究。设置：三所大学附属教学医院。患者：727例患者的连续样本，年龄65岁及以上。测量和主要结果：727例患者中有88例（12%）在入院时出现谵妄。出院和3个月随访时的主要结局指标为死亡、新的疗养院安置、死亡或新的疗养院安置和功能下降。出院时，692例患者中有60例（9%）被安置在新的疗养院，控制基线协变量年龄、性别、痴呆、APACHE II评分和功能测量后，谵妄的校正比值比（OR）为3.0（95%置信区间[CI] 1.4，6.2）。727例患者中有95例（13%）发生死亡或新的疗养院安置（校正OR远谵妄2.1，95% CI 1.1，4.0）。所有地点都有同样的调查结果。谵妄和死亡之间的关联（在727例患者中有35例[5%]）和谵妄与住院时间之间的关联没有统计学意义。在3个月随访时，600例患者中有77例（13%）发生新的疗养院安置（谵妄校正OR 3.0; 95% CI 1.5，6.0）。663例患者中有165例（25%）发生死亡或新的疗养院安置（谵妄校正OR 2.6; 95% CI 1.4，4.5）。所有地点都有同样的调查结果。仅死亡（680例患者中的98例[14%]），谵妄的校正OR为1.6（95% CI 0.8，3.2）。谵妄是一个重要的预测功能下降，在两个出院（调整OR 3.0：95% CI 1.6，5.8）和随访（调整OR 2.7：95% CI 1.4，5.2）。谵妄是医院结局的重要独立预后决定因素，包括新的疗养院安置、死亡或新的疗养院安置，和功能下降-即使在控制了年龄，性别，痴呆，疾病严重程度和功能状态之后。因此，在病例组合调整系统和检查老年人住院结局的研究中，应将谵妄视为一个预后变量。
OBJECTIVE: To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline.DESIGN: Three prospective cohort studies.SETTING: Three university-affiliated teaching hospitals.PATIENTS: Consecutive samples of 727 patients, aged 65 years and older.MEASUREMENTS AND MAIN RESULTS: Delirum was present at admission in 88 (12%) of 727 patients. The main outcome measures at hospital discharge and 3-month follow-up were death, new nursing home placement, death or new nursing home placement, and functional decline. At hospital discharge, new nursing home placement occurred in 60 (9%) of 692 patients, and the adjusted odds ratio (OR) for delirium, controlling for baseline covariates of age, gender, dementia, APACHE II score, and functional measures, was 3.0, (95% confidence interval [CI] 1.4, 6.2). Death or new nursing home placement occurred in 95 (13%) of 727 patients (adjusted OR far delirium 2.1, 95% CI 1.1, 4.0). The findings were replicated across all sites. The associations between delirium and death alone (in 35 [5%] of 727 patients) and between delirium and length of stay were not statistically significant. At 3-month follow-up, new nursing home placement occurred in 77 (13%) of 600 patients (adjusted OR for delirium 3.0; 95% CI 1.5, 6.0). Death or new nursing home placement occurred in 165 (25%) of 663 patients (adjusted OR for delirium 2.6; 95% CI 1.4, 4.5). The findings were replicated across all sites. For death alone (in 98 [14%] of 680 patients), the adjusted OR for delirium was 1.6 (95% CI 0.8, 3.2). Delirium was a significant predictor of functional decline at both hospital discharge (adjusted OR 3.0: 95% CI 1.6, 5.8) and follow-up (adjusted OR 2.7: 95% CI 1.4, 5.2).CONCLUSIONS: Delirium is an important independent prognostic determinant of hospital outcomes including new nursing home placement, death or new nursing home placement, and functional decline - even after controlling for age, gender, dementia, illness severity, and functional status. Thus, delirium should be considered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.