Department of Information Engineering, University of Brescia, v. Branze, 38, 25123, Brescia, Italy.
SC Medicina Generale, Ospedale Sant'Andrea di Vercelli, ASL VC, Vercelli, Italy.
Aging Clin Exp Res. 2021 Oct;33(10):2753-2758. doi: 10.1007/s40520-021-01792-4. Epub 2021 Feb 9.
Delirium is frequent though undetected in older patients admitted to the Emergency Department (ED).
To develop and validate a delirium risk assessment tool for older persons admitted to the ED Observation Unit (OU).
We used data from two samples of 65 + year-old patients, one admitted to the ED of Brescia Hospital (n = 257) and one to the ED of Desio Hospital (n = 107), Italy. Data from Brescia were used as training sample, those collected in Desio as testing one. Delirium was assessed using the 4AT and patients' characteristic were retrieved from medical charts. Variables found to be associated with delirium in the training sample were tested for the creation of a delirium risk assessment tool. The resulting tool's performances were assessed in the testing subsample.
Of all possible scores tested, the combination with the highest discriminative ability in the training sample included: age ≥ 75 years, dementia diagnosis, chronic use of neuroleptics, and hearing impairment. The delirium score exhibited an AUC of 0.874 and 0.893 in the training and testing samples, respectively. For a 1-point increase in the score, the odds of delirium increased more than twice in both samples.
We propose a delirium risk assessing tool that includes variables that can be easily collected at ED admission and that can be calculated rapidly.
A risk assessment tool could help improving delirium detection in older persons referring to ED.
在急诊科（ED）收治的老年患者中，谵妄虽常见但却未被发现。
为 ED 观察单元（OU）收治的老年人开发和验证一种谵妄风险评估工具。
我们使用了来自两个 65 岁以上患者样本的数据，一个来自意大利布雷西亚医院的 ED（n=257），另一个来自迪索医院的 ED（n=107）。布雷西亚的数据被用作训练样本，而迪索的数据则被用作测试样本。使用 4AT 评估谵妄，从病历中检索患者的特征。在训练样本中发现与谵妄相关的变量被用于测试创建谵妄风险评估工具。在测试子样本中评估所得工具的性能。
在所测试的所有可能分数中，在训练样本中具有最高判别能力的组合包括：年龄≥75 岁、痴呆诊断、慢性使用神经安定剂和听力障碍。在训练和测试样本中，谵妄评分的 AUC 分别为 0.874 和 0.893。评分增加 1 分，两个样本中发生谵妄的几率都增加了两倍多。
我们提出了一种谵妄风险评估工具，该工具包含在 ED 入院时可以轻松收集的变量，并且可以快速计算。
风险评估工具可以帮助提高急诊科老年患者谵妄的检测率。
