School of Nursing, The University of Notre Dame, Darlinghurst Campus, Sydney, NSW, Australia.
Palliat Med. 2013 Jun;27(6):486-98. doi: 10.1177/0269216312457214. Epub 2012 Sep 17.
Delirium is a serious neuropsychiatric syndrome frequently experienced by palliative care inpatients. This syndrome is under-recognized by clinicians. While screening increases recognition, it is not a routine practice.
This systematic review aims to examine methods, quality, and results of delirium prevalence and incidence studies in palliative care inpatient populations and discuss implications for delirium screening.
A systematic search of the literature identified prospective studies reporting on delirium prevalence and/or incidence in inpatient palliative care adult populations from 1980 to 2012. Papers not in English or those reporting the occurrence of symptoms not specifically identified as delirium were excluded.
Of the eight included studies, the majority (98.9%) involved participants (1079) with advanced cancer. Eight different screening and assessment tools were used. Delirium incidence ranged from 3% to 45%, while delirium prevalence varied, with a range of: 13.3%-42.3% at admission, 26%-62% during admission, and increasing to 58.8%-88% in the weeks or hours preceding death. Studies that used the Diagnostic and Statistical Manual-Fourth Edition reported higher prevalence (42%-88%) and incidence (40.2%-45%), while incidence rates were higher in studies that screened participants at least daily (32.8%-45%). Hypoactive delirium was the most prevalent delirium subtype (68%-86% of cases).
The prevalence and incidence of delirium in palliative care inpatient settings supports the need for screening. However, there is limited consensus on assessment measures or knowledge of implications of delirium screening for inpatients and families. Further research is required to develop standardized methods of delirium screening, assessment, and management that are acceptable to inpatients and families.
谵妄是姑息治疗住院患者经常发生的一种严重的神经精神综合征。这种综合征被临床医生所忽视。虽然筛查可以提高识别率，但这并不是常规做法。
本系统综述旨在检查姑息治疗住院患者人群中谵妄患病率和（或）发病率研究的方法、质量和结果，并讨论其对谵妄筛查的影响。
系统检索文献，确定了 1980 年至 2012 年期间报告姑息治疗成人住院患者中谵妄患病率和（或）发病率的前瞻性研究。排除了非英语论文或未报告明确诊断为谵妄的症状发生情况的论文。
在所纳入的 8 项研究中，大多数（98.9%）研究对象（1079 人）患有晚期癌症。使用了 8 种不同的筛查和评估工具。谵妄的发病率范围为 3%至 45%，而谵妄的患病率差异较大，入院时为 13.3%至 42.3%，住院期间为 26%至 62%，在死亡前数周或数小时内增加至 58.8%至 88%。使用《精神障碍诊断与统计手册第四版》的研究报告了较高的患病率（42%至 88%）和发病率（40.2%至 45%），而每天至少对参与者进行一次筛查的研究中发病率更高（32.8%至 45%）。低活动型谵妄是最常见的谵妄亚型（68%至 86%的病例）。
姑息治疗住院患者中谵妄的患病率和发病率支持筛查的必要性。然而，在评估措施或对住院患者和家属进行谵妄筛查的影响方面，尚未达成共识。需要进一步研究，以制定可被住院患者和家属接受的标准化谵妄筛查、评估和管理方法。
