LaHue Sara C, Douglas Vanja C, Kuo Teresa, Conell Carol A, Liu Vincent X, Josephson S Andrew, Angel Clay, Brooks Kristen B
Department of Neurology, School of Medicine, University of California, San Francisco, California.
Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California.
J Hosp Med. 2019 Apr;14(4):201-206. doi: 10.12788/jhm.3130.
Delirium affects more than seven million hospitalized adults in the United States annually. However, its impact on postdischarge healthcare utilization remains unclear.
To determine the association between delirium and 30-day hospital readmission.
A retrospective cohort study.
A general community medical and surgical hospital.
All adults who were at least 65 years old, without a history of delirium or alcohol-related delirium, and were hospitalized from September 2010 to March 2015.
The patients deemed at risk for or displaying symptoms of delirium were screened by nurses using the Confusion Assessment Method with a followup by a staff psychiatrist for a subset of screen-positive patients. Patients with delirium confirmed by a staff psychiatrist were compared with those without delirium. The primary outcome was the 30-day readmission rate. The secondary outcomes included emergency department (ED) visits 30 days postdischarge, mortality during hospitalization and 30 days postdischarge, and discharge location.
The cohort included 718 delirious patients and 7,927 nondelirious patients. Using an unweighted multivariable logistic regression, delirium was determined to be significantly associated with the increased odds of readmission within 30 days of discharge (odds ratio (OR): 2.60; 95% CI, 1.96-3.44; P < .0001). Delirium was also significantly (P < .0001) associated with ED visits within 30 days postdischarge (OR: 2.18; 95% CI: 1.77-2.69) and discharge to a facility (OR: 2.52; 95% CI: 2.09-3.01).
Delirium is a significant predictor of hospital readmission, ED visits, and discharge to a location other than home. Delirious patients should be targeted to reduce postdischarge healthcare utilization.
在美国，谵妄每年影响超过700万住院成人。然而，其对出院后医疗保健利用的影响仍不明确。
确定谵妄与30天内再次入院之间的关联。
一项回顾性队列研究。
一家综合社区内科和外科医院。
所有年龄至少65岁、无谵妄或酒精相关谵妄病史且在2010年9月至2015年3月期间住院的成年人。
由护士使用混乱评估方法对被认为有谵妄风险或出现谵妄症状的患者进行筛查，对一部分筛查呈阳性的患者由精神科工作人员进行随访。将经精神科工作人员确诊为谵妄的患者与无谵妄的患者进行比较。主要结局是30天再入院率。次要结局包括出院后30天内的急诊科就诊、住院期间及出院后30天内的死亡率以及出院地点。
该队列包括718例谵妄患者和7927例无谵妄患者。使用未加权多变量逻辑回归分析，确定谵妄与出院后30天内再次入院几率增加显著相关（比值比（OR）：2.60；95%置信区间，1.96 - 3.44；P <.0001）。谵妄还与出院后30天内的急诊科就诊（OR：2.18；95%置信区间：1.77 - 2.69）以及转至医疗机构（OR：2.52；95%置信区间：2.09 - 3.01）显著相关（P <.0001）。
谵妄是医院再入院、急诊科就诊以及出院后转至非家庭地点的重要预测因素。应针对谵妄患者以减少出院后医疗保健利用。
