Abdelrahman Islam, Vieweg Rosa, Irschik Stefan, Steinvall Ingrid, Sjöberg Folke, Elmasry Moustafa
Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden.
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden.
Burns. 2020 Jun;46(4):797-803. doi: 10.1016/j.burns.2020.02.013. Epub 2020 Mar 14.
Delirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns.
In this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay.
Fifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899-0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4-18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality.
We found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.
谵妄被定义为注意力和意识的紊乱，在短时间内发展，是与基线的变化，且通常随时间波动。烧伤护理涉及谵妄已知危险因素的高患病率，如镇静、炎症和长期住院。我们的目的是探讨成年烧伤住院患者谵妄的程度及其相关因素的影响。
在这项回顾性研究中，对四年期间所有成年烧伤住院患者进行了研究，包括仅接受重症监护和中级护理（无重症监护）的患者。使用护理谵妄筛查量表（Nu-DESC）对谵妄评估的每日记录与年龄、性别、烧伤总面积百分比、手术、麻醉下伤口护理程序数量、血浆C反应蛋白浓度及其他临床变量一起进行分析。采用逻辑回归分析与谵妄相关的因素及其对死亡率的影响，采用线性回归分析其对住院时间的影响。
262名患者中，51名（19%）在住院期间至少有一次出现谵妄迹象（Nu-DESC评分≥2）。接受重症监护的89名患者中有42名（47%）记录有谵妄迹象，接受中级护理的173名患者中有9名（5%）记录有谵妄迹象。多变量回归中谵妄的独立因素为：年龄超过74岁；麻醉下手术和伤口护理程序数量；以及提供重症监护（曲线下面积0.940，95%可信区间0.899-0.981）。在调整年龄和烧伤面积后，有谵妄的组住院时间长13.2天（95%可信区间7.4-18.9，p<0.001）。我们未发现谵妄对死亡率有独立影响。
我们发现谵妄与老年、提供重症监护及麻醉下干预次数之间存在密切关联。另外5%未接受重症监护的患者也出现了谵妄迹象，这一发现值得未来深入研究。
