Sri-on Jiraporn, Tirrell Gregory Philip, Vanichkulbodee Alissala, Niruntarai Supa, Liu Shan W
Emergency Department, Massachusetts General Hospital, Boston, Massachusetts, USA Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.
Emergency Department, Massachusetts General Hospital, Boston, Massachusetts, USA.
Emerg Med J. 2016 Jan;33(1):17-22. doi: 10.1136/emermed-2014-204379. Epub 2015 Mar 24.
We sought to determine the prevalence of delirium in a Thai emergency department (ED). The secondary objective was to identify risk factors and short-term outcomes in delirious elderly ED patients.
This was a prospective cross-sectional study in the ED of an urban tertiary care hospital. Patients aged ≥65 years who presented to the ED were included. We excluded patients who had severe dementia, were not responsive to verbal stimuli, had severe trauma and were blind, deaf, aphasic or unable to speak Thai. Delirium was determined using the Confusion Assessment Method for the Intensive Care Unit. We collected 30-day mortality rate, hospital length of stay and revisit rate as short-term outcomes.
We had a final sample size of 232 patients; 27 (12%) were delirious in the ED, of which 16 (59%) were not recognised to be delirious by the emergency physician. Multivariable logistic regression analysis showed dementia (adjusted OR (AOR) 13.1; 95% CI 2.9 to 59.6), auditory impairment (AOR 4.8; 95% CI 1.6 to 13.8) and ED diagnosis of metabolic derangement (AOR 6.5; 95% CI 1.6 to 26.8) were associated with delirium in the ED. Delirium was associated with a higher mortality rate than those without delirium (15% vs 2%, p=0.004).
In one middle-income country, elderly ED patients were delirious >10% of the time. Delirium was underdiagnosed and was associated with an increased 30-day mortality rate. Delirium screening needs to be improved, potentially focusing on high-risk patients.
我们试图确定泰国急诊科（ED）中谵妄的患病率。次要目标是识别谵妄老年急诊患者的危险因素和短期结局。
这是一项在城市三级护理医院急诊科进行的前瞻性横断面研究。纳入年龄≥65岁且到急诊科就诊的患者。我们排除了患有严重痴呆、对言语刺激无反应、有严重创伤以及失明、失聪、失语或不会说泰语的患者。使用重症监护病房的意识模糊评估方法来确定谵妄。我们收集了30天死亡率、住院时间和复诊率作为短期结局。
我们最终的样本量为232例患者；27例（12%）在急诊科出现谵妄，其中16例（59%）未被急诊医生识别为谵妄。多变量逻辑回归分析显示，痴呆（调整后的比值比（AOR）为13.1；95%置信区间为2.9至59.6）、听力障碍（AOR为4.8；95%置信区间为1.6至13.8）和急诊科诊断的代谢紊乱（AOR为6.5；95%置信区间为1.6至26.8）与急诊科谵妄相关。谵妄患者的死亡率高于无谵妄患者（15%对2%，p = 0.004）。
在一个中等收入国家，老年急诊患者谵妄发生率超过10%。谵妄诊断不足，且与30天死亡率增加相关。谵妄筛查需要改进，可能应关注高危患者。
