Department of Psychiatry, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, 25 S Grand Ave, Medical Laboratories B002, Iowa City, IA, 52246.
Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
J Clin Psychiatry. 2019 Sep 3;80(5):19m12749. doi: 10.4088/JCP.19m12749.
Delirium is common and dangerous, yet underdetected and undertreated. Current screening questionnaires are subjective and ineffectively implemented in busy hospital workflows. Electroencephalography (EEG) can objectively detect the diffuse slowing characteristic of delirium, but it is not suitable for high-throughput screening due to size, cost, and the expertise required for lead placement and interpretation. This study hypothesized that an efficient and reliable point-of-care EEG device for high-throughput screening could be developed.
This prospective study, which measured bispectral EEG (BSEEG) from elderly inpatients to assess their outcomes, was conducted at the University of Iowa Hospitals and Clinics from January 2016 to October 2017. A BSEEG score was defined based on the distribution of 2,938 EEG recordings from the 428 subjects who were assessed for delirium; primary outcomes measured were hospital length of stay, discharge disposition, and mortality.
A total of 274 patients had BSEEG score data available for analysis. Delirium and BSEEG score had a significant association (P < .001). Higher BSEEG scores were significantly correlated with length of stay (P < .001 unadjusted, P = .001 adjusted for age, sex, and Charlson Comorbidity Index [CCI] score) as well as with discharge not to home (P < .01). Hazard ratio for survival controlling for age, sex, CCI score, and delirium status was 1.35 (95% CI,1.04 to 1.76; P = .025).
In BSEEG, an efficient and reliable device that provides an objective measurement of delirium status was developed. The BSEEG score is significantly associated with pertinent clinical outcomes of mortality, hospital length of stay, and discharge disposition. The BSEEG score better predicts mortality than does clinical delirium status. This study identified a previously unrecognized subpopulation of patients without clinical features of delirium who are at increased mortality risk.
谵妄很常见且很危险，但却未被充分发现和治疗。目前的筛查问卷主观性强，在繁忙的医院工作流程中实施效果不佳。脑电图（EEG）可以客观地检测出谵妄的弥漫性减慢特征，但由于其体积大、成本高以及需要专业知识来放置和解释导联，因此不适合用于高通量筛查。本研究假设可以开发出一种用于高通量筛查的高效、可靠的床边 EEG 设备。
这项前瞻性研究通过测量老年住院患者的双谱脑电图（BSEEG）来评估他们的预后，于 2016 年 1 月至 2017 年 10 月在爱荷华大学医院和诊所进行。根据对 428 例谵妄评估患者的 2938 次 EEG 记录的分布，定义了 BSEEG 评分；主要结局测量包括住院时间、出院去向和死亡率。
共有 274 例患者的 BSEEG 评分数据可用于分析。谵妄与 BSEEG 评分有显著关联（P <.001）。较高的 BSEEG 评分与住院时间显著相关（P <.001 未调整，P =.001 调整年龄、性别和 Charlson 合并症指数 [CCI] 评分），与出院非居家相关（P <.01）。控制年龄、性别、CCI 评分和谵妄状态后，生存的风险比为 1.35（95%CI，1.04 至 1.76；P =.025）。
在 BSEEG 中，开发了一种高效、可靠的设备，可对谵妄状态进行客观测量。BSEEG 评分与死亡率、住院时间和出院去向等相关临床结局显著相关。BSEEG 评分比临床谵妄状态更能预测死亡率。本研究确定了一个以前未被识别的亚人群，这些患者没有谵妄的临床特征，但死亡风险增加。
