Assess Emergency Department Patients Developing Delirium after Hospital Admission

描述(申请人提供)：精神错乱，一种严重的认知和注意力减退状态，在老年患者中很常见。先前的研究表明，精神错乱与增加的死亡率、住院时间和长期住院设施的出院率之间存在关联。老年住院患者的妄想率较高，为25%~60%，而老年急诊科患者的妄想率较低，约占老年急诊科患者的10%。这表明很大一部分神志不清的住院患者在住院期间会发展成神志不清，而不是出现神志不清。因此，有机会识别有可能发展为精神错乱的ED患者，并针对这一脆弱人群进行针对性的干预，以努力降低医院内精神错乱的发病率。这项研究的总体目标是描述急诊科发展为医院获得性精神错乱的患者亚群的特征，以便这一群体可能成为未来预防精神错乱的目标。这项拨款建议对一项正在进行的基于ED的前瞻性队列研究提出一项辅助研究，该研究利用混淆评估方法评估老年ED患者的精神错乱。家长研究的重点是评估患者在急诊室期间的精神错乱，但不评估入院后精神错乱的发展。在拟议的附属研究中，我们会覆检在急症室没有神志不清而入院的病人的住院纪录。利用一种有效的基于图表的方法，我们将确定这些患者中哪些人在住院期间发生了精神错乱。对于我们的第一个特定目标，我们将评估基于ED的协变量，包括人口统计学、医学信息和来自ED病程的数据，以预测医院获得性妄想。利用多变量回归分析，我们将建立入院后易患妄想的老年患者的概况。在我们的第二个具体目标中，我们将确定向急诊科提出精神错乱的患者、住院期间出现精神错乱的患者和根本没有出现精神错乱的患者在资源利用和结果方面是否存在差异。最后，第三个具体目标将探索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发展为神志不清。通过开发能够成功预测处于医院获得性精神错乱高风险的患者的工具，研究人员和临床医生可以针对这一易受伤害的人群进行预防，最终目标是降低与这种常见综合征相关的发病率、死亡率和医疗费用。 与公共卫生相关：精神错乱是一种认知和注意力下降的急性状态，在老年患者中很常见，与患者发病率和死亡率的显著增加以及每年数十亿美元的卫生保健支出有关。这项研究的总体目标是描述急诊科入院后出现精神错乱的患者的特征，以便这一群体可能成为未来预防精神错乱的目标。

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.