Physicians vary in approaches to the clinical management of delirium
Physicians vary in approaches to the clinical management of delirium
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DOI：
10.1046/j.1532-5415.2003.51063.x
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发表时间：
2003-02-01
影响因子：
6.3
通讯作者：
Knuppel, J
中科院分区：
文献类型：
--
作者：
Carnes, M;Howell, T;Knuppel, J
设计：横断面邮寄调查。设置：美国。部分：美国老年医学会医生成员的概率样本。测量：在一个由两部分组成的病例片段中呈现了一位老年妇女的管理选择，她先是髋部骨折，然后发展为轻度和严重的精神错乱。结果：122名受访者(43%)选择了构成当前最佳实践的三个答案，50名(18%)选择了不必要的诊断性测试(脑成像、腰椎穿刺术或脑电)，47例(17%)选择了不必要的药物治疗。选择药物治疗的有270例(96%)，其中180例单用氟哌啶醇，55例单用劳拉西潘，23例选择劳拉西潘与氟哌啶醇合用，12例用其他药物。30%的受访者选择劳拉西潘单独或与氟哌啶醇联合治疗轻度或重度精神错乱。在选择氟哌啶醇治疗严重精神错乱的患者中，61%的人选择了比老年患者推荐的剂量更大的剂量。性别、医学院毕业日期、临床专业、完成老年研究员研究或老年医学证书对反应没有显著影响。结论：劳拉西潘治疗妄想症的常见选择是令人担忧的，因为苯二氮卓类药物本身与妄想症有关。选择的氟哌啶醇初始剂量高于超过一半的受访者为老年患者推荐的剂量也令人担忧。缺乏可靠的临床证据来指导选择药物治疗老年住院患者的神志不清。
OBJECTIVES: To ascertain the variation in strategies for managing delirium of physicians with expertise in geriatrics.DESIGN: Cross-sectional mail survey.SETTING: United States.PARTICIPANTS: A probability sample of physician members of the American Geriatrics Society.MEASUREMENTS: Management choices presented in a two-part case vignette of an older woman hospitalized with a hip fracture who develops mild and then severe delirium.RESULTS: One hundred twenty-two respondents (43%) selected the three answers constituting current "best practice," 50 (18%) selected an unnecessary diagnostic test (brain imaging, lumbar puncture, or electroencephalogram), and 47 (17%) selected unnecessary pharmacologic therapy for mild delirium. For severe delirium, 270 (96%) selected pharmacological therapy, of whom 180 chose haloperidol alone, 55 chose lorazepam alone, 23 chose lorazepam in combination with haloperidol, and 12 wrote in another drug. Thirty percent of the respondents made any selection of lorazepam, alone or in combination with haloperidol, for mild or severe delirium. Sixty-one percent of those selecting haloperidol for severe delirium chose a dose greater than that recommended for geriatric patients. Sex, date of graduation from medical school, clinical specialty, completion of a geriatric fellowship, or certification in geriatrics had no significant effect on responses.CONCLUSIONS: The common selection of lorazepam to treat delirium is troubling because benzodiazepines themselves are implicated in delirium. Selection of an initial dose of haloperidol higher than that recommended for geriatric patients by more than half of the respondents is also of concern. There is a paucity of sound clinical evidence to guide the choice of pharmacological agents for treating delirium in older hospitalized patients.