Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tubingen, Hoppe-Seyler-Str.3, 72076, Tubingen, Germany.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1017-1024. doi: 10.1007/s00068-021-01603-5. Epub 2021 Feb 4.
Delirium in trauma surgery is common, especially post-operatively, but medical characteristics, risk factors and residence post-discharge have not comprehensively been investigated in all trauma patients.
Over 1 year, 2026 trauma patients were prospectively screened for delirium with the following tools: Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5, nursing tool (ePA-AC) construct. Risk factors-predisposing und precipitating-for delirium were assessed via multiple regression analysis.
Of 2026 trauma patients, 440 (21.7%) developed delirium, which was associated with an increased risk of assisted living (OR 6.42, CI 3.92-10.49), transfer to nursing home (OR 4.66, CI 3.29-6.6), rehabilitation (OR 3.96, CI 3.1-5.1), or death (OR 70.72, CI 22-227.64). Intensive care management (OR 18.62, CI 14.04-24.68), requirement of ventilation (OR 32.21, CI 21.27-48.78), or its duration (OR 67.22, CI 33.8-133.71) all increased the risk for developing delirium. Relevant predisposing risk factors were dementia (OR 50.92, CI 15.12-171.45), cardiac insufficiency (OR 11.76, CI 3.6-38.36), and polypharmacy (OR 5.9, CI 4.01-8.68).Relevant precipitating risk factors were brain edema (OR 40.53, CI 4.81-341.31), pneumonia (OR 39.66, CI 8.89-176.93) and cerebral inflammation (OR 21.74, CI 2.34-202.07).
Delirium in trauma patients is associated with poor outcome as well as with intensive care management and various predisposing and/or precipitating factors. Three quarters of patients who had undergone delirium were not able to live independently at home any more.
创伤手术后谵妄很常见，尤其是术后，但尚未全面调查所有创伤患者的医学特征、危险因素和出院后去向。
在 1 年多的时间里，对 2026 名创伤患者进行了谵妄的前瞻性筛查，使用的工具包括：谵妄观察筛选量表（DOS）、重症监护谵妄筛查检查表（ICDSC）和 DSM-5 护理工具（ePA-AC）。使用多元回归分析评估了谵妄的潜在危险因素和诱发因素。
在 2026 名创伤患者中，440 名（21.7%）发生了谵妄，这与辅助生活（OR 6.42，95%CI 3.92-10.49）、转移至疗养院（OR 4.66，95%CI 3.29-6.6）、康复（OR 3.96，95%CI 3.1-5.1）或死亡（OR 70.72，95%CI 22-227.64）的风险增加有关。重症监护管理（OR 18.62，95%CI 14.04-24.68）、需要通气（OR 32.21，95%CI 21.27-48.78）或通气持续时间（OR 67.22，95%CI 33.8-133.71）均增加了发生谵妄的风险。相关的潜在危险因素包括痴呆（OR 50.92，95%CI 15.12-171.45）、心功能不全（OR 11.76，95%CI 3.6-38.36）和多药治疗（OR 5.9，95%CI 4.01-8.68）。相关的诱发危险因素包括脑水肿（OR 40.53，95%CI 4.81-341.31）、肺炎（OR 39.66，95%CI 8.89-176.93）和脑炎症（OR 21.74，95%CI 2.34-202.07）。
创伤患者的谵妄与不良预后以及重症监护管理以及各种潜在和/或诱发因素有关。发生谵妄的患者中，有四分之三的患者无法再独立在家生活。
