Ritter Simone R F, Cardoso Anne F, Lins Marina M P, Zoccoli Thayana L V, Freitas Marco Polo D, Camargos Einstein F
Multidisciplinary Center for the Elderly, University Hospital of Brasília, University of Brasília (UnB), Brasília/DF, Brazil.
Postgraduate in Medical Sciences, Faculty of Medicine, University of Brasilia (UnB), Brasília/DF, Brazil.
Psychogeriatrics. 2018 Jul;18(4):268-275. doi: 10.1111/psyg.12324.
Delirium is a common and poorly diagnosed cause of behavioral change in elderly. This study aimed to estimate the prevalence, diagnostic accuracy and factors associated with the onset of delirium in the elderly admitted to an urgency unit.
Cross-sectional study including clinically stable subjects aged ≥60 years between April and June of 2014. Diagnosis of delirium based on the Confusion Assessment Method (CAM, gold standard) was compared to the subjective assessment made by physicians on duty as recorded in the medical chart. Association of sociodemographic, psychological/behavioural, and clinical variables with delirium was assessed using multivariate analysis.
A sample of 110 participants with a mean age of 72.7 ± 8.3 years was studied. Of these, 56.4% were men and 28.2% had a diagnosis of delirium on CAM. Significant associations were observed between delirium and male gender (P-value = 0.019), poor or very poor self-perception of health (P-value = 0.033), previous diagnosis of dementia (P-value = 0.001), previous history of stroke (P-value = 0.014), and acute bacterial infection (P-value = 0.008). Physician diagnosis had a sensitivity of 35.5%, specificity of 100%, and accuracy of 81.8% to detect delirium. Rate of misdiagnosis was 64.5%.
Delirium was underdiagnosed in this urgent care hospital setting.
谵妄是老年人行为改变的常见且诊断不足的原因。本研究旨在估计入住急症科的老年人谵妄的患病率、诊断准确性及与谵妄发作相关的因素。
采用横断面研究，纳入2014年4月至6月间年龄≥60岁且临床状况稳定的受试者。将基于意识模糊评估法（CAM，金标准）诊断的谵妄与病历中值班医生的主观评估进行比较。使用多变量分析评估社会人口学、心理/行为和临床变量与谵妄的相关性。
研究了110名平均年龄为72.7±8.3岁的参与者。其中，56.4%为男性，28.2%经CAM诊断为谵妄。观察到谵妄与男性性别（P值=0.019）、健康自我认知差或非常差（P值=0.033）、既往痴呆诊断（P值=0.001）、既往中风史（P值=0.014）和急性细菌感染（P值=0.008）之间存在显著关联。医生诊断检测谵妄的敏感性为35.5%，特异性为100%，准确性为81.8%。误诊率为64.5%。
在这家急诊医院环境中，谵妄诊断不足。
