Departments of Anaesthesia and care of the elderly, Queen's Hospital, Barking Havering and Redbridge NHS Trust, London, UK.
Central London School of Anaesthesia, London, UK.
Psychogeriatrics. 2020 Jul;20(4):495-500. doi: 10.1111/psyg.12518. Epub 2020 Feb 11.
Delirium is a common postoperative neurocognitive complication in the older population and can lead to significant morbidity and mortality, as well as cognitive and functional impairment. Hypoactive delirium is characterised by drowsiness and inactivity, and expert opinions suggest that it is more likely to be missed and can lead to more complications. Current guidelines and literature evidence both support the use of non-pharmacological management of delirium.
To investigate the recognition of hyperactive and hypoactive delirium by the surgical multidisciplinary team, and to investigate staff understanding regarding the management and prognosis of postoperative delirium. We conducted a single-centre, multidisciplinary survey on the diagnosis, management and complication of postoperative delirium.
We found that hypoactive delirium is significantly less likely to be identified. In contrast, acute psychosis is likely to be misdiagnosed as delirium. Only a small proportion of the respondents had knowledge of the supportive management options for delirium; and the medical complications and higher mortality risk associated with postoperative delirium.
The finding of the survey demonstrates a need for delirium education. Surveys such as this may be conducted in other centres to identify areas of focus on staff delirium education.
谵妄是老年人群中一种常见的术后神经认知并发症，可导致显著的发病率和死亡率，以及认知和功能障碍。低活动度谵妄的特征是嗜睡和不活动，专家意见表明，它更容易被忽视，并可能导致更多的并发症。目前的指南和文献证据都支持使用非药物治疗来管理谵妄。
调查外科多学科团队对活跃性和不活跃性谵妄的识别，以及对术后谵妄的管理和预后的理解。我们进行了一项单中心、多学科的术后谵妄诊断、管理和并发症调查。
我们发现，不活跃性谵妄明显不太可能被识别。相比之下，急性精神病更有可能被误诊为谵妄。只有一小部分受访者了解谵妄的支持性管理选择，以及与术后谵妄相关的医疗并发症和更高的死亡率风险。
调查结果表明需要进行谵妄教育。可以在其他中心进行类似的调查，以确定员工谵妄教育的重点领域。
