Hare Malcolm, Arendts Glenn, Wynaden Dianne, Leslie Gavin
Fremantle Hospital, Fremantle, Australia.
University of Western Australia, Nedlands, Australia.
Psychosomatics. 2014 May-Jun;55(3):235-42. doi: 10.1016/j.psym.2013.08.007. Epub 2013 Dec 5.
Delirium in older emergency department (ED) patients is common, associated with many adverse outcomes, and costly to manage. Delirium detection in the ED is almost universally poor.
The authors aimed to develop a simple clinical risk screening tool that could be used by ED nurses as part of their initial assessment to identify patients at risk of delirium.
A prospective cross-sectional study of patients 65 years and older attending a single ED.
Of 320 enrolled patients, 23 (7.2%) had delirium. Logistic regression analysis revealed 3 risk factors strongly associated with delirium risk: cognitive impairment, depression, and an abnormal heart rate/rhythm. Weighting these variables based on the strength of their association with delirium yielded a risk score from 0-4 inclusive. A cutoff of 2 or more in that score would have given a sensitivity of 87%, specificity of 70%, and NPV of 99%, while avoiding further diagnostic workup for delirium in approximately two-thirds of all patients, when used as an initial screen.
A simple risk screening tool using factors evident on initial nurse assessment can be used to identify patients at risk of delirium. Further trials are needed to test whether the tool improves patient outcomes.
老年急诊科患者谵妄很常见，与许多不良后果相关，且管理成本高昂。急诊科对谵妄的检测普遍较差。
作者旨在开发一种简单的临床风险筛查工具，急诊科护士可将其作为初始评估的一部分，用于识别有谵妄风险的患者。
对一家急诊科65岁及以上患者进行前瞻性横断面研究。
在320名登记患者中，23名（7.2%）患有谵妄。逻辑回归分析显示，3个风险因素与谵妄风险密切相关：认知障碍、抑郁和心率/心律异常。根据这些变量与谵妄的关联强度进行加权，得出0至4（含）的风险评分。该评分2分及以上时，灵敏度为87%，特异度为70%，阴性预测值为99%，用作初始筛查时，可避免约三分之二的患者进行谵妄的进一步诊断检查。
一种使用护士初始评估时明显因素的简单风险筛查工具，可用于识别有谵妄风险的患者。需要进一步试验来检验该工具是否能改善患者预后。
