Siddiqi Najma, House Allan O, Holmes John D
Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9LT, UK.
Age Ageing. 2006 Jul;35(4):350-64. doi: 10.1093/ageing/afl005. Epub 2006 Apr 28.
Despite the acknowledged clinical importance of delirium, research evidence for measures to improve its management is sparse. A necessary first step to devising appropriate strategies is to understand how common it is and what its outcomes are in any particular setting.
To determine the occurrence of delirium and its outcomes in medical in-patients, through a systematic review of the literature.
We searched electronic medical databases, the Consultation-Liaison Literature Database and reference lists and bibliographies for potentially relevant studies. Studies were selected, quality assessed and data extracted according to preset protocols.
Results for the occurrence of delirium in medical in-patients were available for 42 cohorts. Prevalence of delirium at admission ranged from 10 to 31%, incidence of new delirium per admission ranged from 3 to 29% and occurrence rate per admission varied between 11 and 42%. Results for outcomes were available for 19 study cohorts. Delirium was associated with increased mortality at discharge and at 12 months, increased length of hospital stay (LOS) and institutionalisation. A significant proportion of patients had persistent symptoms of delirium at discharge and at 6 and 12 months.
Delirium is common in medical in-patients and has serious adverse effects on mortality, functional outcomes, LOS and institutionalisation. The development of appropriate strategies to improve its management should be a clinical and research priority. As delirium prevalent at hospital admission is a significant problem, research is also needed into preventative measures that could be applied in community settings.
尽管谵妄在临床上的重要性已得到公认，但关于改善其管理措施的研究证据却很少。制定适当策略的必要第一步是了解其在任何特定环境中的常见程度及其后果。
通过对文献的系统评价，确定住院内科患者谵妄的发生率及其后果。
我们检索了电子医学数据库、会诊联络文献数据库以及参考文献列表和书目，以查找潜在相关研究。根据预设方案选择研究、评估质量并提取数据。
有42个队列提供了住院内科患者谵妄发生率的结果。入院时谵妄的患病率为10%至31%，每次入院新发生谵妄的发生率为3%至29%，每次入院的发生率在11%至42%之间。有19个研究队列提供了关于后果的结果。谵妄与出院时和12个月时死亡率增加、住院时间（LOS）延长以及入住养老院有关。相当一部分患者在出院时以及6个月和12个月时有持续的谵妄症状。
谵妄在住院内科患者中很常见，对死亡率、功能结局、住院时间和入住养老院有严重不良影响。制定适当的策略以改善其管理应成为临床和研究的重点。由于入院时普遍存在的谵妄是一个重大问题，还需要对可应用于社区环境的预防措施进行研究。
