Singler K, Thiem U, Christ M, Zenk P, Biber R, Sieber C C, Heppner H-J
Abteilung für Geriatrie, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Germany,
Z Gerontol Geriatr. 2014 Dec;47(8):680-5. doi: 10.1007/s00391-014-0615-z.
The prevalence of delirium in hospitalized patients is high, but delirium is frequently not identified by treating physicians in emergency departments (EDs). Although the number of elderly patients admitted to EDs is increasing, no data on prevalence, identification and outcome of delirious elderly patients in German EDs exist.
To evaluate the prevalence and identification of delirium in elderly patients in a German ED and to identify characteristics of delirium in elderly ED patients.
Evaluation of data from a prospective single-center observational study. The study was conducted in the interdisciplinary ED of an urban university-affiliated hospital receiving approximately 80,000 visits per year. The shortened Confusion Assessment Method (CAM) was used to screen 133 consecutive ED patients, aged 75 years and older, for delirium. Comorbid conditions were ascertained by patient interview and review of medical records. Data concerning patient mortality and current living status were collected 28 days after the ED visit in a structured telephone interview.
A positive CAM result was recorded in 14.3 % of cases; 68.4 % of these CAM-positive patients were not identified as being delirious by the ED physician. The 28-day mortality was higher among patients with delirium. Dependency on external help, polypharmacy, pre-existing cognitive or mobility impairments and the presence of any care level were strongly associated with delirium.
Elderly patients with known risk factors should be routinely assessed for delirium in the ED with a standardized assessment tool such as the CAM.
住院患者中谵妄的患病率很高，但急诊科（ED）的主治医生常常未能识别出谵妄。尽管入住急诊科的老年患者数量在增加，但德国急诊科中关于谵妄老年患者的患病率、识别情况及转归的数据尚不存在。
评估德国一家急诊科中老年患者谵妄的患病率及识别情况，并确定老年急诊科患者谵妄的特征。
对一项前瞻性单中心观察性研究的数据进行评估。该研究在一所城市大学附属医院的跨学科急诊科开展，该急诊科每年接诊约80000人次。采用简化版意识模糊评估法（CAM）对133例年龄在75岁及以上的连续急诊科患者进行谵妄筛查。通过患者访谈和病历审查确定共病情况。在急诊科就诊28天后，通过结构化电话访谈收集有关患者死亡率和当前生活状况的数据。
14.3%的病例CAM结果呈阳性；这些CAM阳性患者中有68.4%未被急诊科医生识别为谵妄。谵妄患者的28天死亡率更高。对外部帮助的依赖、多重用药、既往存在的认知或行动能力损害以及任何护理级别与谵妄密切相关。
对于有已知危险因素的老年患者，应在急诊科使用标准化评估工具（如CAM）对谵妄进行常规评估。
