Hustey FM, Meldon S, Palmer R
The Cleveland Clinic Foundation, Cleveland, OH.
Acad Emerg Med. 2000 Oct;7(10):1166.
To determine the prevalence and assess documentation by emergency department (ED) physicians (EPs) of impaired mental status in elderly ED patients. METHODS: Cross-sectional, observational study. Subjects: convenience sampling of ED patients greater than or equal to 70 years of age. Patients were screened for cognitive impairment with the Orientation Memory Concentration exam (OMC), and for delirium with the Confusion. Assessment Method screening tool (CAM). A positive OMC or CAM was considered indicative of impaired mental status. Patients with delirium were excluded from the cognitive impairment screen. EPs were blinded to screening results. Physician documentation, dispositions, and referrals were abstracted from chart review. Proportions and 95% confidence intervals (CIs) are reported. RESULTS: 180 patients were screened. 46 patients (26%; 95% CI = 19% to 32%) had impaired mental status. 22 of these (12%; 95% CI = 7% to 17%) had delirium, and 24 (13%; 95% CI = 8% to 18%) had moderate to severe cognitive impairment. Of all patients with impaired mental status, only 14 (30%; 95% CI = 18% to 46%) had documentation of any impairment by the EP (10 with delirium (46%; 95% CI = 24% to 68%), and 5 with cognitive impairment (21%; 95% CI = 7% to 42%). 7 of 22 (32%; 95% CI = 14% to 55%) patients with delirium were discharged home. Only 2 of 16 patients with impaired mental status (12.5%) were discharged home with plans noted to address the impairment. CONCLUSIONS: Impairment in mental status is highly prevalent among older ED patients. Lack of documentation and referrals by EPs suggests lack of recognition of these problems. Further education of physicians is needed to improve care in these areas.
确定老年急诊患者精神状态受损的患病率，并评估急诊科医生（EPs）对此的记录情况。方法：横断面观察性研究。研究对象：采用便利抽样法选取年龄大于或等于70岁的急诊患者。使用定向记忆注意力测试（OMC）筛查患者的认知障碍，并用混乱评估法筛查工具（CAM）筛查谵妄。OMC或CAM结果呈阳性被视为精神状态受损。谵妄患者被排除在认知障碍筛查之外。EPs对筛查结果不知情。通过病历审查提取医生的记录、处置情况及转诊信息。报告比例和95%置信区间（CIs）。结果：共筛查了180例患者。46例患者（26%；95%CI=19%至32%）存在精神状态受损。其中22例（12%；95%CI=7%至17%）患有谵妄，24例（13%；95%CI=8%至18%）存在中度至重度认知障碍。在所有精神状态受损的患者中，只有14例（30%；95%CI=18%至46%）有EPs记录的任何损伤情况（10例谵妄患者（46%；95%CI=24%至68%），5例认知障碍患者（21%；95%CI=7%至42%））。22例谵妄患者中有7例（32%；95%CI=14%至55%）出院回家。16例精神状态受损的患者中只有2例（12.5%）出院回家，并制定了应对损伤的计划。结论：精神状态受损在老年急诊患者中非常普遍。EPs缺乏记录和转诊表明对这些问题缺乏认识。需要对医生进行进一步培训，以改善这些方面的护理。
