Assess Emergency Department Patients Developing Delirium after Hospital Admission

描述（由申请人提供）：谵妄是一种认知和注意力下降的急性状态，常见于老年患者。先前的研究表明谵妄与死亡率增加、住院时间和延长住院率之间存在关联。虽然住院老年患者中谵妄的患病率很高，从25%到60%不等，但老年急诊科（ED）患者中谵妄的患病率要低得多，约为老年ED患者的10%。这表明很大比例的谵妄住院患者在住院期间发展为谵妄，而不是表现为谵妄。因此，有机会识别有发展为谵妄风险的ED患者，并针对这一弱势群体进行有针对性的干预，以减少院内谵妄的发病率。本研究的总体目标是表征急诊科发生医院获得性谵妄的患者亚组，以便这一组患者可能成为未来谵妄预防工作的目标。这项拨款提出了一项辅助研究，以正在进行的前瞻性ED为基础的队列研究，该研究利用混乱评估方法评估老年ED患者的谵妄。父母的研究侧重于评估患者在急诊科时的谵妄，但没有评估入院后谵妄的发展。在拟议的辅助研究中，我们将回顾那些在急诊科没有神志不清而入院的患者的住院记录。利用一种有效的基于图表的方法，我们将确定哪些患者在住院期间出现了谵妄。对于我们的第一个具体目标，我们将评估基于ED的协变量，包括人口统计学、医学信息和ED课程的数据，以预测医院获得性谵妄。利用多变量回归分析，我们将对入院后谵妄风险增加的老年患者进行分析。在我们的第二个具体目标中，我们将确定在急诊室出现谵妄的患者、住院期间出现谵妄的患者和根本没有出现谵妄的患者之间，资源利用和结果是否存在差异。最后，第三个具体目标将探讨生物标志物是否具有诊断潜力，以确定哪些患者在入院后会出现谵妄。通过开发能够成功预测医院获得性谵妄高风险患者的工具，研究人员和临床医生可以针对这一脆弱人群进行谵妄预防工作，最终目标是降低与这种常见综合征相关的发病率、死亡率和医疗保健费用。

DESCRIPTION (provided by applicant): Delirium, an acute state of diminished cognition and attention, is common in elderly patients. Prior studies demonstrate an association between delirium and increased mortality, length of hospitalization, and rates of discharge to an extended stay facility. While the prevalence of delirium among hospitalized elderly patients is high, ranging from 25 to 60%, the prevalence of delirium among elderly Emergency Department (ED) patients is much lower, approximately 10% of elderly ED patients. This suggests that a large proportion of delirious inpatients develop delirium while in the hospital, as opposed to presenting with delirium. Thus, there is opportunity to identify ED patients at risk of developing delirium, and targeting interventions towards this vulnerable population in an effort to reduce the morbidity from in-hospital delirium. The overall goal of this study is to characterize the subgroup of Emergency Department patients who develop hospital acquired delirium, such that this group may be targeted for delirium prevention efforts in the future. This grant proposes an ancillary study to an ongoing prospective ED-based cohort study that evaluates elderly ED patients for delirium utilizing the Confusion Assessment Method. The parent study focuses on evaluating patients for delirium while in the ED, but does not assess for the development of delirium after admission. In the proposed ancillary study, we will review the inpatient records of patients who were not delirious in the ED and were admitted to the hospital. Utilizing a validated chart-based method, we will determine which of these patients developed delirium while hospitalized. For our first specific aim, we will assess ED-based covariates, including demographics, medical information, and data from the ED course, in the prediction of hospital-acquired delirium. Utilizing multivariable regression analysis, we will develop a profile of elderly patients at increased risk for delirium after admission. In our second specific aim, we will determine whether there are differences in resource utilization and outcomes among patients who present to the ED with delirium, patients who develop delirium while hospitalized, and patients who do not develop delirium at all. Finally, the third specific aim will explore whether biomarkers hold diagnostic potential in identifying which patients will develop delirium after admission. By developing tools that can successfully predict patients who are at high risk of hospital-acquired delirium, researchers and clinicians can target this vulnerable population for delirium prevention efforts with the ultimate goal of decreasing morbidity, mortality, and health care costs associated with this common syndrome. PUBLIC HEALTH RELEVANCE: Delirium, an acute state of diminished cognition and attention, is common in elderly patients and associated with a significant increase in patient morbidity and mortality, and billions of dollars in annual health care expenditures. The overall goal of this study is to characterize the subgroup of Emergency Department patients who develop delirium after hospital admission, such that this group may be targeted for delirium prevention efforts in the future.