Delirium in the emergency department: an independent predictor of death within 6 months.
Delirium in the emergency department: an independent predictor of death within 6 months.
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DOI：
10.1016/j.annemergmed.2010.03.003
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发表时间：
2010-09
影响因子：
6.2
通讯作者：
Ely, E. Wesley
中科院分区：
文献类型：
--
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
谵妄对老年住院患者长期死亡率的不良影响已有大量文献记载，而其对老年急诊科（艾德）患者的影响尚不清楚。同样地，在艾德院看到的精神错乱对疗养院病人的影响也是未知的。因此，我们试图确定艾德的谵妄是否与老年患者的6个月死亡率独立相关，以及这种关系是否因疗养院状况而改变。我们的前瞻性队列研究在三级护理、学术艾德中使用方便抽样进行，纳入了65岁及以上、入组时在艾德中少于12小时的讲英语的患者。如果患者拒绝知情同意、既往入组、基线时无法遵循简单命令、昏迷或数据不完整，则将其排除。使用重症监护病房（CAM-ICU）的混乱评估方法确定谵妄，并由经过培训的研究助理进行管理。采用考克斯比例风险回归分析确定艾德患者在校正年龄、合并症负担、疾病严重程度、痴呆、功能依赖和疗养院居住后，谵妄是否与6个月死亡率独立相关。为了检验艾德中谵妄对6个月死亡率的影响是否被疗养院居住所改变，将交互作用项（谵妄 * 疗养院）纳入多变量模型。报告了风险比（HR）及其95%置信区间（95% CI）。在入组的628例患者中，108例（17.2%）在艾德发生谵妄，58例（9.2%）来自疗养院。对于整个队列，与非谵妄组相比，谵妄组的6个月死亡率更高（37.0% vs 14.3%）。在调整年龄、合并症负担、疾病严重程度、痴呆、功能依赖和疗养院居住后，谵妄是6个月死亡率增加的独立预测因素（HR = 1.72，95%CI：1.04 - 2.86）。“谵妄 * 疗养院”的相互作用是不显着的（p=0.86），表明居住地没有影响谵妄之间的关系，在艾德和6个月的死亡率。老年艾德患者的谵妄是6个月死亡率增加的独立预测因素，无论是否在疗养院，这种关系似乎都存在。
Delirium’s adverse effect on long-term mortality in older hospitalized patients is well documented, while its effect in older emergency department (ED) patients remains unclear. Similarly, the consequences of delirium on nursing home patients seen in the ED are also unknown. As a result, we sought to determine if delirium in the ED was independently associated with 6-month mortality in older patients and if this relationship was modified by nursing home status. Our prospective cohort study was conducted at a tertiary care, academic ED using convenience sampling, and included English speaking patients who were 65 years and older and were in the ED for less than 12 hours at the time of enrollment. Patients were excluded if they refused consent, were previously enrolled, were unable to follow simple commands at baseline, were comatose, or had incomplete data. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to determine delirium and was administered by trained research assistants. Cox proportional hazard regression was performed to determine if delirium in the ED was independently associated with 6-month mortality after adjusting for age, comorbidity burden, severity of illness, dementia, functional dependence, and nursing home residence. To test whether the effect of delirium in the ED on 6-month mortality was modified by nursing home residence, an interaction term (delirium*nursing home) was incorporated into the multivariable model. Hazard ratios (HR) with their 95% confidence intervals (95% CI) were reported. Of the 628 patients enrolled, 108 (17.2%) were delirious in the ED and 58 (9.2%) were from the nursing home. For the entire cohort, the 6-month mortality rate was higher in the delirious group compared to the non-delirious group (37.0% versus 14.3%). Delirium was an independent predictor of increased 6-month mortality (HR = 1.72, 95% CI: 1.04 – 2.86) after adjusting for age, comorbidity burden, severity of illness, dementia, functional dependence, and nursing home residence. The “delirium*nursing home” interaction was non-significant (p=0.86), indicating that place of residence had no effect on the relationship between delirium in the ED and 6-month mortality. Delirium in older ED patients is an independent predictor of increased 6-month mortality and this relationship appears to be present regardless of nursing home status.
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DOI：
10.1093/gerona/60.6.748
发表时间：
2005-06-01
影响因子：
5.1
作者：
Fick, DM;Kolanowski, AM;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
37.8
作者：
Antman, Elliott M.;Hand, Mary;Smith, Sidney C., Jr.
通讯作者：
Smith, Sidney C., Jr.
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
DOI：
10.1111/j.1532-5415.2005.00489.x
发表时间：
2005-12-01
影响因子：
6.3
作者：
Bercovitz, A;Gruber-Baldini, AL;Hebel, JR
通讯作者：
Hebel, JR
DOI：
10.1111/j.1532-5415.1991.tb03568.x
发表时间：
1991-12-01
影响因子：
6.3
作者：
BERGMAN, H;CLARFIELD, AM
通讯作者：
CLARFIELD, AM