Matsuoka Ayaka, Miike Toru, Miyazaki Mariko, Goto Taku, Sasaki Akira, Yamazaki Hirotaka, Komaki Moe, Higuchi Masahiro, Mori Kosuke, Shinada Kota, Nakayama Kento, Sakurai Ryota, Asahi Miho, Futami Akiko, Yoshitake Kunimasa, Narumi Shougo, Koba Mayuko, Koami Hiroyuki, Kawaguchi Atsushi, Murakawa Toru Hirachi, Monji Akira, Sakamoto Yuichirou
Emergency and Critical Care Medicine, Saga University Hospital, Saga City, Japan.
Education and Research Center for Community Medicine, Saga University, Saga, Japan.
Trauma Surg Acute Care Open. 2021 Nov 29;6(1):e000827. doi: 10.1136/tsaco-2021-000827. eCollection 2021.
Delirium has been shown to prolong the length of intensive care unit stay, hospitalization, and duration of ventilatory control, in addition to increasing the use of sedatives and increasing the medical costs. Although there have been a number of reports referring to risk factors for the development of delirium, no model has been developed to predict delirium in trauma patients at the time of admission. This study aimed to create a scoring system that predicts delirium in trauma patients.
In this single-center, retrospective, observational study, trauma patients aged 18 years and older requiring hospitalization more than 48 hours were included and divided into the development and validation cohorts. Univariate analysis was performed in the development cohort to identify factors significantly associated with prediction of delirium. The final scoring system for predicting delirium was developed using multivariate analysis and internal validation was performed.
Of the 308 patients in the development cohort, 91 developed delirium. Clinical Frailty Score, fibrin/fibrinogen degradation products, low body mass index, lactate level, and Glasgow Coma Scale score were independently associated with the development of delirium. We developed a scoring system using these factors and calculated the delirium predictive score, which had an area under the curve of 0.85. In the validation cohort, 46 of 206 patients developed delirium. The area under the curve for the validation cohort was 0.86, and the calibration plot analysis revealed the scoring system was well calibrated in the validation cohort.
This scoring system for predicting delirium in trauma patients consists of only five risk factors. Delirium prediction at the time of admission may be useful in clinical practice.
Prognostic and epidemiological, level III.
谵妄已被证明会延长重症监护病房住院时间、住院时长和通气控制时间，此外还会增加镇静剂的使用并提高医疗成本。尽管已有多篇报告提及谵妄发生的危险因素，但尚未建立模型来预测创伤患者入院时是否会发生谵妄。本研究旨在创建一个预测创伤患者谵妄的评分系统。
在这项单中心、回顾性、观察性研究中，纳入了年龄在18岁及以上、需要住院超过48小时的创伤患者，并将其分为开发队列和验证队列。在开发队列中进行单因素分析，以确定与谵妄预测显著相关的因素。使用多因素分析开发了预测谵妄的最终评分系统，并进行了内部验证。
在开发队列的308例患者中，91例发生了谵妄。临床衰弱评分、纤维蛋白/纤维蛋白原降解产物、低体重指数、乳酸水平和格拉斯哥昏迷量表评分与谵妄的发生独立相关。我们使用这些因素开发了一个评分系统，并计算了谵妄预测分数，其曲线下面积为0.85。在验证队列中，206例患者中有46例发生了谵妄。验证队列的曲线下面积为0.86，校准图分析显示该评分系统在验证队列中校准良好。
这个预测创伤患者谵妄的评分系统仅由五个危险因素组成。入院时预测谵妄在临床实践中可能有用。
预后和流行病学，III级。
