McAvay Gail J, Van Ness Peter H, Bogardus Sidney T, Zhang Ying, Leslie Douglas L, Leo-Summers Linda S, Inouye Sharon K
Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut 06510, USA.
J Am Geriatr Soc. 2006 Aug;54(8):1245-50. doi: 10.1111/j.1532-5415.2006.00815.x.
To compare 1-year institutionalization and mortality rates of patients who were delirious at discharge, patients whose delirium resolved by discharge, and patients who were never delirious in the hospital.
Secondary analysis of prospective cohort data from the Delirium Prevention Trial.
General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998, with follow-up interviews completed in 2000.
Four hundred thirty-three patients aged 70 and older who were not delirious at admission.
Patients underwent daily assessments of delirium from admission to discharge using the Confusion Assessment Method. Nursing home placement and mortality were determined at 1-year follow up.
Of the 433 study patients, 24 (5.5%) had delirium at discharge, 31 (7.2%) had delirium that resolved during hospitalization, and 378 (87.3%) were never delirious. After 1 year of follow-up, 20 of 24 (83.3%) patients discharged with delirium, 21 of 31 (67.7%) patients whose delirium resolved, and 157 of 378 (41.5%) patients who were never delirious were admitted to a nursing home or died. Compared with patients who were never delirious, patients with delirium at discharge had a multivariable adjusted hazard ratio (HR) of 2.64 (95% confidence interval (CI)=1.60-4.35) for nursing home placement or mortality, whereas resolved cases had a HR of 1.53 (95% CI=0.96-2.43).
Delirium at discharge is associated with a high rate of nursing home placement and mortality over a 1-year follow-up period. Interventions to increase detection of delirium and improvements in transitional care may help reduce these negative outcomes.
比较出院时存在谵妄的患者、出院时谵妄已缓解的患者以及住院期间从未出现谵妄的患者的1年机构收容率和死亡率。
对谵妄预防试验的前瞻性队列数据进行二次分析。
1995年3月25日至1998年3月18日期间在耶鲁纽黑文医院的普通内科病房，2000年完成随访访谈。
433名70岁及以上入院时未出现谵妄的患者。
使用意识错乱评估法对患者从入院到出院进行每日谵妄评估。在1年随访时确定养老院安置情况和死亡率。
在433名研究患者中，24名（5.5%）出院时存在谵妄，31名（7.2%）在住院期间谵妄得到缓解，378名（87.3%）从未出现谵妄。经过1年随访，出院时存在谵妄的24名患者中有20名（83.3%）、谵妄得到缓解的31名患者中有21名（67.7%）以及从未出现谵妄的378名患者中有157名（41.5%）被送入养老院或死亡。与从未出现谵妄的患者相比，出院时存在谵妄的患者在养老院安置或死亡方面的多变量调整风险比（HR）为2.64（95%置信区间（CI）=1.60 - 4.35），而谵妄缓解的患者HR为1.53（95%CI = 0.96 - 2.43）。
出院时存在谵妄与1年随访期内较高的养老院安置率和死亡率相关。增加谵妄检测的干预措施和改善过渡性护理可能有助于减少这些不良后果。
