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住院康复设施中的谵妄筛查和管理。

Delirium Screening and Management in Inpatient Rehabilitation Facilities.

机构信息

From the Burke Rehabilitation Hospital, White Plains, New York (MO-P); Kessler Foundation, West Orange, New Jersey (PC, OB, AMB); Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers-the State University of New Jersey, Newark, New Jersey (PC, OB, AMB); Kessler Institute for Rehabilitation, Chester, New Jersey (VR-N, AMB); and University of Washington, Seattle, Washington (KH).

出版信息

Am J Phys Med Rehabil. 2018 Oct;97(10):754-762. doi: 10.1097/PHM.0000000000000962.

Abstract

Delirium is an acute and fluctuating disturbance in cognition attention and awareness that is often a reflection of abnormal physiological condition of an individual. Delirium is highly prevalent among an older population and is associated with high mortality, poor medical and functional outcomes, and high healthcare cost. Delirium often has iatrogenic triggers, and it has been recognized as a quality indicator of healthcare organizations. Despite its high prevalence and significance, more than 50% of the delirium cases are underrecognized by healthcare professionals and remained untreated. Most patients in inpatient rehabilitation facilities are older adults with multiple risk factors for delirium including operation, intensive care stay, multiple co-morbidities, and impaired mobility. Early detection, intervention, and primary prevention of delirium will allow patients to avoid additional morbidities and reach their maximum functional potential during their rehabilitation stay. After the systematic implementation of delirium screening in our inpatient rehabilitation facility, we found that 10.3% of patients were screened positive for delirium at admission. This review discusses the systematic implementation of screening and intervention for delirium as well as the epidemiology of delirium to increase the awareness and guide clinical practice for clinicians in inpatient rehabilitation facilities.

摘要

谵妄是一种急性和波动性的认知、注意力和意识障碍,通常反映了个体的异常生理状况。谵妄在老年人群中很常见,与高死亡率、较差的医疗和功能结局以及高医疗保健成本相关。谵妄通常有医源性诱因,并已被认为是医疗保健组织的质量指标。尽管其患病率和重要性很高,但超过 50%的谵妄病例仍未被医疗保健专业人员识别和未得到治疗。大多数住院康复设施的患者是老年人,存在多种谵妄风险因素,包括手术、重症监护停留、多种合并症和活动能力受损。早期发现、干预和预防谵妄将使患者在康复期间避免额外的发病和达到其最大的功能潜力。在我们的住院康复设施中系统地实施谵妄筛查后,我们发现 10.3%的入院患者筛查出谵妄阳性。本综述讨论了谵妄的筛查和干预以及谵妄的流行病学,以提高住院康复设施中临床医生的认识并指导临床实践。

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