LaMantia Michael A, Messina Frank C, Hobgood Cherri D, Miller Douglas K
Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Ann Emerg Med. 2014 May;63(5):551-560.e2. doi: 10.1016/j.annemergmed.2013.11.010. Epub 2013 Dec 16.
Older adults who visit emergency departments (EDs) often experience delirium, but it is infrequently recognized. A systematic review was therefore conducted to identify what delirium screening tools have been used in ED-based epidemiologic studies of delirium, whether there is a validated set of screening instruments to identify delirium among older adults in the ED or prehospital environments, and an ideal schedule during an older adult's visit to perform a delirium evaluation. MEDLINE/EMBASE, Cochrane, PsycINFO, and CINAHL databases were searched from inception through February 2013 for original, English-language research articles reporting on the assessment of older adults' mental status for delirium. Twenty-two articles met all study inclusion criteria. Overall, 7 screening instruments were identified, though only 1 has undergone initial validation for use in the ED environment and a second instrument is currently undergoing such validation. Minimal information was identified to suggest the ideal scheduling of a delirium assessment process to maximize the recognition of this condition in the ED. Study results indicate that several delirium screening tools have been used in investigations in the ED, though validation of these instruments for this particular environment has been minimal to date. The ideal interval(s) during which a delirium screening process should take place has yet to be determined. Research will be needed both to validate delirium screening instruments to be used for investigation and clinical care in the ED and to define the ideal timing and form of the delirium assessment process for older adults.
前往急诊科就诊的老年人常出现谵妄，但这种情况却很少被识别出来。因此，开展了一项系统评价，以确定在基于急诊科的谵妄流行病学研究中使用了哪些谵妄筛查工具，是否有一套经过验证的筛查工具可用于识别急诊科或院前环境中的老年人谵妄，以及在老年人就诊期间进行谵妄评估的理想时间安排。检索了MEDLINE/EMBASE、Cochrane、PsycINFO和CINAHL数据库，从建库至2013年2月，查找报告老年人谵妄精神状态评估的英文原创研究文章。22篇文章符合所有研究纳入标准。总体而言，共识别出7种筛查工具，不过只有1种已在急诊科环境中进行了初步验证，另一种工具目前正在进行此类验证。关于谵妄评估过程的理想时间安排，以在急诊科最大限度地识别这种情况的相关信息极少。研究结果表明，急诊科的调查中使用了几种谵妄筛查工具，但迄今为止，这些工具在这一特定环境中的验证工作做得很少。谵妄筛查过程应在的理想间隔时间尚未确定。需要开展研究，以验证用于急诊科调查和临床护理的谵妄筛查工具，并确定老年人谵妄评估过程的理想时间和形式。
