McCoy Thomas H, Hart Kamber L, Perlis Roy H
Center for Quantitative Health, Division of Clinical Research, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, United States; Avery D. Weisman Psychiatry Consultation Service, Massachusetts General Hospital, Warren Building 6th Floor, 55 Fruit St, Boston, MA 02114, United States.
Center for Quantitative Health, Division of Clinical Research, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, United States.
Gen Hosp Psychiatry. 2017 May;46:1-6. doi: 10.1016/j.genhosppsych.2017.01.006. Epub 2017 Jan 26.
To better understand variation in reported rates of delirium, this study characterized delirium occurrence rate by department of service and primary admitting diagnosis.
Nine consecutive years (2005-2013) of general hospital admissions (N=831,348) were identified across two academic medical centers using electronic health records. The primary admitting diagnosis and the treating clinical department were used to calculate occurrence rates of a previously published delirium definition composed of billing codes and natural language processing of discharge summaries.
Delirium rates varied significantly across both admitting diagnosis group (X=12786, p<0.001) and department of care (X=12106, p<0.001). In both cases obstetrical admissions showed the lowest incidences of delirium (86/109764; 0.08%) and neurological admissions the greatest (2851/25450; 11.2%). Although the rate of delirium varied across the two hospitals the relative rates within departments (r=0.96, p<0.001) and diagnostic categories (r=0.98, p<0.001) were consistent across the two institutions.
The frequency of delirium varies significantly across admitting diagnosis and hospital department. Both admitting diagnosis and department of care are even stronger predictors of risk than age; as such, simple risk stratification may offer avenues for targeted prevention and treatment efforts.
为了更好地理解谵妄报告率的差异，本研究按服务科室和主要入院诊断对谵妄发生率进行了特征描述。
利用电子健康记录，在两个学术医疗中心确定了连续九年（2005 - 2013年）的综合医院入院病例（N = 831348）。主要入院诊断和治疗临床科室用于计算由计费代码和出院小结自然语言处理组成的先前发表的谵妄定义的发生率。
谵妄发生率在入院诊断组（X = 12786，p < 0.001）和护理科室（X = 12106，p < 0.001）中均有显著差异。在这两种情况下，产科入院患者的谵妄发生率最低（86/109764；0.08%），神经科入院患者的发生率最高（2851/25450；11.2%）。尽管两家医院的谵妄发生率有所不同，但各科室（r = 0.96，p < 0.001）和诊断类别（r = 0.98，p < 0.001）内的相对发生率在两个机构中是一致的。
谵妄的发生率在入院诊断和医院科室之间存在显著差异。入院诊断和护理科室都是比年龄更强的风险预测因素；因此，简单的风险分层可能为有针对性的预防和治疗努力提供途径。
