Marcantonio Edward R, Kiely Dan K, Simon Samuel E, John Orav E, Jones Richard N, Murphy Katharine M, Bergmann Margaret A
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
J Am Geriatr Soc. 2005 Jun;53(6):963-9. doi: 10.1111/j.1532-5415.2005.53305.x.
To compare outcomes of patients admitted to postacute skilled nursing facilities with delirium, subsyndromal delirium, and no delirium.
Observational cohort study.
Seven skilled nursing facilities that specialize in postacute care within a single metropolitan region.
Five hundred four subjects chosen from 1,248 consenting subjects aged 65 and older who underwent mental status testing within 5 days of admission to the participating facilities. Subjects who met full Confusion Assessment Method (CAM) criteria were classified as delirious, those with one or more CAM criteria were classified as having subsyndromal delirium, and those with no CAM features were classified as having no delirium. All subjects with delirium and with available medical records were included. A random subset of subjects with no delirium and subsyndromal delirium with available medical records was included.
The medical records of all subjects underwent a structured review by trained research nurses who were masked to the subjects' initial delirium status. Records were reviewed for the development of new complications within the postacute setting and to determine whether the subjects were discharged within 30 days and, if so, the discharge destination. The National Death Index was used to assess 6-month mortality.
Subjects with delirium were more likely to experience one or more complications than subjects with no delirium (73% vs 41%, P < .01). Within 30 days of postacute admission, subjects with delirium were more than twice as likely to be rehospitalized (30% vs 13%), and less than half as likely to be discharged to the community (30% vs 73%) than subjects without delirium (differences P < .01). Subjects with subsyndromal delirium had outcomes intermediate between those with and without delirium. Finally, subjects admitted to the postacute setting with delirium experienced a 6-month mortality rate of 25.0%, compared with 5.7% in subjects admitted without delirium. Subjects with subsyndromal delirium had a 6-month mortality rate of 18.3%.
Patients admitted to postacute skilled nursing facilities with delirium are more likely to experience complications, rehospitalization, and death than patients without delirium. These findings support the need for improved case finding and management of delirium in postacute care.
比较入住急性后期专业护理机构的谵妄患者、亚综合征性谵妄患者和无谵妄患者的预后情况。
观察性队列研究。
一个大都市地区内七家专门提供急性后期护理的专业护理机构。
从1248名年龄在65岁及以上且在参与研究的机构入院5天内接受精神状态测试的同意参与研究的受试者中选取504名。符合完全意识模糊评估法（CAM）标准的受试者被分类为谵妄患者，符合一项或多项CAM标准的受试者被分类为患有亚综合征性谵妄，无CAM特征的受试者被分类为无谵妄。纳入所有患有谵妄且有可用病历的受试者。随机纳入一部分有可用病历的无谵妄和亚综合征性谵妄受试者。
所有受试者的病历由经过培训的研究护士进行结构化审查，这些护士对受试者最初的谵妄状态不知情。审查病历以了解急性后期环境中是否出现新的并发症，并确定受试者是否在30天内出院，若出院，出院目的地。使用国家死亡指数评估6个月死亡率。
与无谵妄的受试者相比，谵妄患者更有可能出现一种或多种并发症（73%对41%，P<.01）。在急性后期入院30天内，谵妄患者再次住院的可能性是无谵妄患者的两倍多（30%对13%），出院回家的可能性不到无谵妄患者的一半（30%对73%）（差异P<.01）。亚综合征性谵妄患者的预后介于谵妄患者和无谵妄患者之间。最后，急性后期入院时患有谵妄的受试者6个月死亡率为25.0%，而无谵妄入院的受试者为5.7%。亚综合征性谵妄患者的6个月死亡率为18.3%。
入住急性后期专业护理机构的谵妄患者比无谵妄患者更有可能出现并发症、再次住院和死亡。这些发现支持在急性后期护理中改善谵妄的病例发现和管理的必要性。
