老年创伤患者发生谵妄的风险很高，尤其是那些患有潜在痴呆症或基线虚弱的患者。
Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty.
作者信息
Ní Chróinín Danielle, Francis Nevenka, Wong Pearl, Kim Yewon David, Nham Susan, D'Amours Scott
机构信息
Department of Geriatric Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.
South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia.
出版信息
Trauma Surg Acute Care Open. 2021 Apr 27;6(1):e000639. doi: 10.1136/tsaco-2020-000639. eCollection 2021.
BACKGROUND
Given the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay-and patient factors associated therewith-and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).
METHODS
We conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.
RESULTS
Among 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).
DISCUSSION
In this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.
LEVEL OF EVIDENCE
III.
背景
鉴于创伤老年患者数量不断增加，以及谵妄对治疗结果的潜在影响，我们试图调查此类患者在住院期间被诊断为谵妄的比例、与之相关的患者因素，以及谵妄与住院时间（LOS）之间的潜在关联。我们假设谵妄很常见，与某些患者特征相关，并与较长的住院时间（最高四分位数）相关。
方法
我们对2019年9月至10月就诊的所有年龄≥65岁的创伤患者进行了一项回顾性观察队列研究，查阅了病历和机构创伤数据库。主要结局指标是谵妄的发生情况。
结果
在99名符合条件的患者中，谵妄很常见，有23%（99例中的23例）有记录。在多变量分析中，在调整年龄、虚弱和痴呆病史后，虚弱（比值比[OR]4.09，95%置信区间[CI]1.08至15.53，p = 0.04）和痴呆（OR 5.23，95%CI 1.38至19.90，p = 0.02）与谵妄发生的可能性独立相关。标准化评估工具使用不足，只有34%（99例中的34例）在到达后4小时内进行了筛查。在单变量逻辑回归分析中，发生谵妄与较长的住院时间（最高四分位数）相关，OR为5.29（95%CI 1.92至14.56，p<0.001）。在最终的多变量模型中，在调整任何（非谵妄）院内并发症后，谵妄与较长的住院时间（≥16天；OR 4.81，p = 0.005）独立相关。
讨论
在本研究中，谵妄很常见。痴呆病史和基线虚弱与风险增加相关。谵妄与较长的住院时间独立相关。然而，许多患者在入院时未接受标准化筛查。对有谵妄风险的老年患者进行早期识别和针对性管理可能会降低发病率并改善对这一脆弱群体的护理。这些数据只是提出假设，但支持开展改善谵妄护理的举措的必要性，同时认识到在老年创伤患者中虚弱与其他老年综合征之间存在复杂的相互作用。
证据级别
III级。
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