Boucher Valérie, Lamontagne Marie-Eve, Nadeau Alexandra, Carmichael Pierre-Hugues, Yadav Krishan, Voyer Philippe, Pelletier Mathieu, Gouin Émilie, Daoust Raoul, Berthelot Simon, Morin Michèle, Lemire Stéphane, Minh Vu Thien Tuong, Lee Jacques, Émond Marcel
Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada; Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec city, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Laval, Québec, Canada; Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada.
Faculté de Médecine, Université Laval, Laval, Québec, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada.
J Emerg Med. 2019 Oct;57(4):535-542. doi: 10.1016/j.jemermed.2019.05.024. Epub 2019 Jul 26.
It is documented that health professionals from various settings fail to detect > 50% of delirium cases.
This study aimed to describe the proportion of unrecognized incident delirium in five emergency departments (EDs). Secondary objectives were to compare the two groups (recognized/unrecognized) and assess the impact of unrecognized delirium at 60 days regarding 1) unplanned consultations and 2) functional and cognitive decline.
This is a sub-analysis of a multicenter prospective cohort study. Independent patients aged ≥ 65 years who tested negative for delirium on the initial interview with an ED stay ≥ 8 h were enrolled. Patients were assessed twice daily using the Confusion Assessment Method (CAM) and the Delirium Index up to 24 h into hospital admission. Medical records were reviewed to assess whether delirium was recognized or not.
The main study reported a positive CAM in 68 patients. Three patients' medical files were incomplete, leaving a sample of 65 patients. Delirium was recognized in 15.4% of our participants. These patients were older (p = 0.03) and female (p = 0.01) but were otherwise similar to those with unrecognized delirium. Delirium Index scores were higher in patients with recognized delirium (p = 0.01) and they experienced a more important functional decline at 60 days (p = 0.02). No association was found between delirium recognition and health care services utilization or decline in cognitive function.
This study confirms reports of high rates of missed or unrecognized delirium (84.6%) in ED patients compared to routine structured screening using the CAM performed by a research assistant. Patients with recognized delirium were older women with a greater severity of symptoms and experienced a more significant functional decline at 60 days.
有文献记载，来自不同机构的医护人员未能检测出超过50%的谵妄病例。
本研究旨在描述五个急诊科（ED）中未被识别的新发谵妄的比例。次要目标是比较两组（被识别/未被识别），并评估60天时未被识别的谵妄对1）非计划会诊和2）功能及认知衰退的影响。
这是一项多中心前瞻性队列研究的子分析。纳入年龄≥65岁、在急诊首次就诊时谵妄检测呈阴性且急诊留观时间≥8小时的独立患者。患者在入院后24小时内每天使用混乱评估法（CAM）和谵妄指数进行两次评估。查阅病历以评估谵妄是否被识别。
主要研究报告68例患者CAM呈阳性。3例患者的病历不完整，剩余65例患者作为样本。15.4%的参与者的谵妄被识别。这些患者年龄较大（p = 0.03）且为女性（p = 0.01），但在其他方面与未被识别谵妄的患者相似。被识别谵妄的患者谵妄指数得分更高（p = 0.01），且在60天时功能衰退更严重（p = 0.02）。未发现谵妄识别与医疗服务利用或认知功能衰退之间存在关联。
本研究证实了与研究助理使用CAM进行的常规结构化筛查相比，急诊患者中漏诊或未被识别的谵妄发生率较高（84.6%）。被识别谵妄的患者为年龄较大的女性，症状更严重，且在60天时功能衰退更显著。
