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、住院时间延长和出院到延长住院设施的比率之间存在关联。虽然住院老年患者中谵妄的患病率很高，范围为25%至60%，但老年急诊科（艾德）患者中谵妄的患病率要低得多，约为老年艾德患者的10%。这表明大部分谵妄住院患者在住院期间发生谵妄，而不是表现为谵妄。因此，有机会确定艾德患者在发展谵妄的风险，并有针对性地对这一弱势群体的干预措施，努力减少院内谵妄的发病率。本研究的总体目标是描述发生医院获得性谵妄的急诊科患者亚组的特征，以便将来可以将该组作为谵妄预防工作的目标。该基金建议对一项正在进行的前瞻性ED队列研究进行辅助研究，该研究使用混乱评估方法评估老年艾德患者的谵妄。母研究侧重于评价患者在艾德期间的谵妄，但未评估入院后谵妄的发生。在拟定的辅助研究中，我们将审查在艾德未出现谵妄且入院的患者的住院记录。利用一个有效的图表为基础的方法，我们将确定这些患者中的哪些发展谵妄，而住院。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，医疗信息和来自艾德课程的数据，在预测医院获得性谵妄。利用多变量回归分析，我们将建立一个老年患者入院后谵妄风险增加的概况。在我们的第二个具体目标中，我们将确定在艾德就诊的谵妄患者、住院期间发生谵妄的患者和根本没有发生谵妄的患者之间在资源利用和结局方面是否存在差异。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，以确定哪些患者将在入院后发生谵妄。通过开发可以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.