老年急诊科患者的谵妄是住院时间延长的独立预测因素。
Delirium in older emergency department patients is an independent predictor of hospital length of stay.
机构信息
Department of Emergency Medicine (JHH, ABS, Division of General Internal Medicine and Public Health (JS, RSD), Vanderbilt University Medical Center, Nashville, TN, USA.
出版信息
Acad Emerg Med. 2011 May;18(5):451-7. doi: 10.1111/j.1553-2712.2011.01065.x. Epub 2011 Apr 26.
OBJECTIVES
The consequences of delirium in the emergency department (ED) remain unclear. This study sought to determine if delirium in the ED was an independent predictor of prolonged hospital length of stay (LOS).
METHODS
This prospective cohort study was conducted at a tertiary care, academic ED from May 2007 to August 2008. The study included English-speaking patients aged 65 and older who were in the ED for less than 12 hours at enrollment. Patients were excluded if they refused consent, were previously enrolled, were unable to follow simple commands at baseline, were comatose, or did not have a delirium assessment performed by the research staff. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to determine delirium status. Patients who were discharged directly from the ED were considered to have a hospital LOS of 0 days. To determine if delirium in the ED was independently associated with time to discharge, Cox proportional hazard regression was performed adjusted for age, comorbidity burden, severity of illness, dementia, functional impairment, nursing home residence, and surgical procedure. A sensitivity analysis, which included admitted patients only, was also performed.
RESULTS
A total of 628 patients met enrollment criteria. The median age was 75 years (interquartile range [IQR] = 69-81), 365 (58%) patients were female, 111 (18%) were nonwhite, 351 (56%) were admitted to the hospital, and 108 (17%) were delirious in the ED. Median LOS was 2 days (IQR = 0-5.5) for delirious ED patients and 1 day (IQR = 0-3) for nondelirious ED patients (p < 0.001). The hazard ratio (HR) of delirium for time to discharge was 0.71 (95% confidence interval [CI] = 0.57 to 0.89) after adjusting for confounders, and indicated that ED patients with delirium were more likely to have prolonged hospital LOS compared with those without delirium. For the sensitivity analysis, which included only hospitalized patients, the adjusted HR was 0.76 (95% CI = 0.58 to 0.99).
CONCLUSIONS
Delirium in older ED patients has negative consequences and is an independent predictor of prolonged hospitalizations.
目的
急诊科（ED）谵妄的后果仍不清楚。本研究旨在确定 ED 中的谵妄是否是延长住院时间（ LOS ）的独立预测因素。
方法
这是一项于 2007 年 5 月至 2008 年 8 月在三级护理、学术性急诊科进行的前瞻性队列研究。研究纳入了年龄在 65 岁及以上、入组时在急诊科的时间少于 12 小时且能讲英语的患者。如果患者拒绝同意、已入组、在基线时无法执行简单命令、昏迷或未接受研究人员进行的谵妄评估，则将其排除在外。使用重症监护病房谵妄评估方法（CAM-ICU）确定谵妄状态。直接从 ED 出院的患者被认为住院 LOS 为 0 天。为确定 ED 中的谵妄是否与出院时间独立相关，进行了 Cox 比例风险回归分析，调整了年龄、合并症负担、疾病严重程度、痴呆、功能障碍、疗养院居住和手术程序。还进行了一项敏感性分析，该分析包括仅入组的住院患者。
结果
共有 628 名患者符合入组标准。中位年龄为 75 岁（四分位距 [IQR] = 69-81），365 名（58%）患者为女性，111 名（18%）为非白人，351 名（56%）患者住院，108 名（17%）在 ED 中出现谵妄。谵妄 ED 患者的中位 LOS 为 2 天（IQR = 0-5.5），非谵妄 ED 患者的 LOS 为 1 天（IQR = 0-3）（p <0.001）。调整混杂因素后，谵妄对出院时间的危害比（HR）为 0.71（95%置信区间 [CI] = 0.57 至 0.89），表明与无谵妄的患者相比，ED 中有谵妄的患者更有可能延长住院时间。对于仅包括住院患者的敏感性分析，调整后的 HR 为 0.76（95% CI = 0.58 至 0.99）。
结论
老年 ED 患者的谵妄有不良后果，是延长住院时间的独立预测因素。
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