住院癌症患儿的谵妄记录。

Delirium documentation in hospitalized pediatric patients with cancer.

机构信息

Pediatric Hematology, Oncology and Palliative Care, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA.

Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA.

出版信息

Palliat Support Care. 2021 Jun;19(3):283-286. doi: 10.1017/S1478951521000171.

DOI:10.1017/S1478951521000171

PMID:33641695

Abstract

OBJECTIVE

Screening tools for delirium are being used more consistently in pediatric critical care. However, screening is not universal, and delirium may be underdiagnosed, misdiagnosed, or undocumented in hospitalized patients. We evaluated the identification and documentation of delirium in pediatric oncology and bone marrow transplant patients.

METHOD

A retrospective chart review on all hospitalized pediatric oncology and bone marrow transplant patients admitted to an Academic Cancer center between 2013 and 2016. Patients aged less than 21 years of age with active cancer were included. Patients with major psychiatric conditions, developmental delays, or autism were excluded. Data were collected to characterize documentation concerning the identification and diagnosis of delirium.

RESULTS

Of 201 hospitalization records, 54 (26.9%) admissions from 109 unique patients had documentation of delirium. The overall documented incidence of delirium was 3.2% of hospitalizations or 8.2% of unique patients. Patients prescribed opioids and benzodiazepines were more likely to have documentation of delirium. ICD coding under-reported delirium while physician documentation was inaccurate in 26% (53/201) when compared with the chart review.

SIGNIFICANCE OF RESULTS

Delirium was frequently undocumented or miscoded. Implementing a validated, universal screening tool for delirium may improve identification and clinical outcomes.

摘要

目的

在儿科重症监护中，越来越多地使用用于谵妄的筛查工具。但是，筛查并非普遍存在，并且在住院患者中可能存在漏诊、误诊或未记录的谵妄。我们评估了儿科肿瘤学和骨髓移植患者中谵妄的识别和记录情况。

方法

对 2013 年至 2016 年期间在学术癌症中心住院的所有儿科肿瘤学和骨髓移植患者进行回顾性病历审查。纳入年龄小于 21 岁且患有活动性癌症的患者。排除有重大精神疾病，发育迟缓或自闭症的患者。收集数据以描述有关谵妄识别和诊断的记录情况。

结果

在 201 份住院记录中，有 54 份（26.9％）来自 109 位患者的住院记录中有谵妄记录。住院患者中谵妄的总记录发生率为 3.2％，独特患者中为 8.2％。接受阿片类药物和苯二氮䓬类药物治疗的患者更有可能记录有谵妄。与病历审查相比，ICD 编码对谵妄的报告不足，而医生记录在 26％（53/201）的情况下不准确。