Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission.
Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission.
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DOI：
10.1136/bmjopen-2015-007808
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发表时间：
2015-11-16
期刊：
影响因子：
2.9
通讯作者：
Rothwell PM
中科院分区：
文献类型：
--
作者：
Pendlebury ST;Lovett NG;Smith SC;Dutta N;Bendon C;Lloyd-Lavery A;Mehta Z;Rothwell PM
我们的目的是确定急性医学中谵妄的年龄特异性发病率和相关因素，以及谵妄对死亡率和长期随访中再入院的影响。观察性研究。在两个8周的时间段（2010年，2012年）内，使用意识模糊评估方法（CAM）对连续性患者进行了入院时谵妄筛查，此后每天进行复查。谵妄诊断使用诊断和统计手册第四版（DSM IV）标准进行。对于年龄≥65岁的患者，收集了既往研究中确定的潜在重要协变量，并对死亡和再次入院进行随访，直至2014年1月。 503例连续患者（中位年龄=72，范围16-99岁，236例（48%）男性）。 急性内科。101/503例（20%）患者发生谵妄（71例入院时，30例入院时，17例两者均发生），风险从<65岁时的3%（6/195）增加到65-74岁时的14%（10/74）和≥75岁时的36%（85/234）（p<0.0001）。 在308例年龄>65岁的患者中 ，校正年龄后，谵妄与既往福尔斯有关（OR=2.47，95% CI 1.45至4.22，p=0.001），既往痴呆（2.08，1.10至3.93，p=0.024），依赖性（2.58，1.48至4.48，p=0.001），认知评分低（5.00，2.50至9.99，p<0.0001），脱水（3.53，1.91至6.53，p<0.0001），重度疾病（1.98，1.17至3.38，p=0.011），压疮风险（5.56，2.60至11.88，p<0.0001）和感染（4.88，2.85至8.36，p<0.0001）。精神错乱的病人更容易摔倒（OR=4.55，1.47 ~ 14.05，p=0.008），尿失禁（3.76，2.15 - 6.58，p<0.0001）或粪便（3.49，1.81-6.73，p=0.0002）和导管插入（5.08，2.44 - 10.54，p<0.0001）;谵妄与住院>7天相关 （2.82，1.68至4.75，p<0.0001），死亡（4.56，1.71至12.17，p=0.003），幸存者的依赖性增加（2.56，1.37至4.76，p=0.003），2年随访时死亡率仍然明显过高。谵妄患者在30天内（OR= 0. 32，95% CI 0. 09 - 1. 1，p= 0. 07）和总体（中位数，IQR总再入院=0. 0-1 vs 1. 0-2，p= 0. 0 - 1）的再入院较少。谵妄影响了五分之一的急性医疗入院和三分之一的年龄≥75岁的患者，并与死亡率，住院和依赖性增加有关，但与随访时再次入院的风险增加无关。
We aimed to determine age-specific rates of delirium and associated factors in acute medicine, and the impact of delirium on mortality and re-admission on long-term follow-up. Observational study. Consecutive patients over two 8-week periods (2010, 2012) were screened for delirium on admission, using the confusion assessment method (CAM), and reviewed daily thereafter. Delirium diagnosis was made using the Diagnostic and Statistical Manual Fourth Edition (DSM IV) criteria. For patients aged ≥65 years, potentially important covariables identified in previous studies were collected with follow-up for death and re-admission until January 2014. 503 consecutive patients (age median=72, range 16–99 years, 236 (48%) male). Acute general medicine. Delirium occurred in 101/503 (20%) (71 on admission, 30 during admission, 17 both), with risk increasing from 3% (6/195) at <65 years to 14% (10/74) for 65–74 years and 36% (85/234) at ≥75 years (p<0.0001). Among 308 patients aged >65 years, after adjustment for age, delirium was associated with previous falls (OR=2.47, 95% CI 1.45 to 4.22, p=0.001), prior dementia (2.08, 1.10 to 3.93, p=0.024), dependency (2.58, 1.48 to 4.48, p=0.001), low cognitive score (5.00, 2.50 to 9.99, p<0.0001), dehydration (3.53, 1.91 to 6.53, p<0.0001), severe illness (1.98, 1.17 to 3.38, p=0.011), pressure sore risk (5.56, 2.60 to 11.88, p<0.0001) and infection (4.88, 2.85 to 8.36, p<0.0001). Patients with delirium were more likely to fall (OR=4.55, 1.47 to 14.05, p=0.008), be incontinent of urine (3.76, 2.15 to 6.58, p<0.0001) or faeces (3.49, 1.81–6.73, p=0.0002) and be catheterised (5.08, 2.44 to 10.54, p<0.0001); and delirium was associated with stay >7 days (2.82, 1.68 to 4.75, p<0.0001), death (4.56, 1.71 to 12.17, p=0.003) and an increase in dependency among survivors (2.56, 1.37 to 4.76, p=0.003) with excess mortality still evident at 2-year follow-up. Patients with delirium had fewer re-admissions within 30-days (OR=0.32, 95% CI 0.09 to 1.1, p=0.07) and in total (median, IQR total re-admissions=0, 0–1 vs 1, 0–2, p=0.01). Delirium affected a fifth of acute medical admissions and a third of those aged ≥75 years, and was associated with increased mortality, institutionalisation and dependency, but not with increased risk of re-admission on follow-up.