Arendts Glenn, Love Jennefer, Nagree Yusuf, Bruce David, Hare Malcolm, Dey Ian
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
University of Western Australia, Nedlands, Western Australia, Australia.
J Am Geriatr Soc. 2017 Aug;65(8):1810-1815. doi: 10.1111/jgs.14904. Epub 2017 Jul 4.
To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults.
Prospective trial with sequential introduction of screening and interventional processes.
Two tertiary referral hospitals in Australia.
Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905).
Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission MEASUREMENTS: Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay.
Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes.
确定捆绑式风险筛查与预警或行动卡系统是否能改善住院老年人的谵妄正式诊断及以患者为中心的结局。
采用序贯引入筛查和干预流程的前瞻性试验。
澳大利亚的两家三级转诊医院。
65岁及以上到急诊科就诊且无需立即进行复苏的患者（N = 3905）。
急诊科正式的谵妄筛查算法，并使用风险预警卡，其中包含后续住院期间预防和管理谵妄的一系列推荐行动。
出院时的谵妄诊断、转至新的辅助生活安排的出院比例、住院并发症（使用镇静剂、跌倒、吸入性肺炎、死亡）、住院时间。
风险筛查呈阳性的参与者发生谵妄的可能性显著更高（相对风险 = 6.0，95%置信区间 = 4.9 - 7.3），且在三个研究阶段中，筛查呈阳性的高危参与者比例保持不变。接受最终干预（第3阶段）的参与者的谵妄检出率为12.1%（与基线率相比，绝对增加2%，相对增加17%），但这无统计学意义（P = 0.29），未接受干预的参与者随时间推移也出现了类似的相对增加。
急诊科的风险筛查与预警或行动卡干预并未显著提高谵妄检出率或其他重要结局。
