Department of Emergency Medicine, The University of Iowa Carver College of Medicine, USA.
Department of Emergency Medicine, The University of Iowa Carver College of Medicine, USA.
J Psychosom Res. 2022 Feb;153:110704. doi: 10.1016/j.jpsychores.2021.110704. Epub 2021 Dec 16.
Delirium is a common and serious brain dysfunction. The objective of our study was to test the hypothesis that opioids and benzodiazepines exposure in the emergency department (ED) is associated with delirium.
This was a retrospective cohort study, including patients aged 65 years and older who were hospitalized from ED at an academic medical center from 2014 to 2017. Medication administration records were used to identify opioids and benzodiazepines given during the ED stay. Nurses used the Delirium Observation Screening Scale (DOSS) twice daily to assess delirium during hospitalization. The outcome was a positive DOSS within 1 day of ED encounter. We used logistic regression to predict the outcome of positive delirium screening by opioids and benzodiazepines.
A total of 7927 ED encounters that resulted in hospitalization were included in the analysis. We identified 2008 visits (25.3%) with a positive delirium screen. A total of 3304 (41.7%) received opioids, and 1801 (22.7%) received benzodiazepines. In this cohort, opioids were not associated with an increased odds of delirium (OR 1.00, 95% CI 0.87-1.15). Benzodiazepines were associated with increased odds of delirium (OR 1.37, 95% CI 1.13-1.65), as were benzodiazepines combined with opioids (OR 1.61, 95% CI 1.33-1.97).
In this study, the use of benzodiazepines was associated with a risk of delirium. The use of opioids did not increase the risk of delirium. Our findings imply that judicious pain management with opioids in the ED might not increase the risk of delirium.
谵妄是一种常见且严重的脑功能障碍。本研究旨在验证以下假设，即在急诊科（ED）使用阿片类药物和苯二氮䓬类药物与谵妄有关。
这是一项回顾性队列研究，纳入了 2014 年至 2017 年期间在学术医疗中心的 ED 住院的年龄在 65 岁及以上的患者。用药记录用于确定 ED 住院期间给予的阿片类药物和苯二氮䓬类药物。护士每天使用两次谵妄观察筛查量表（DOSS）评估住院期间的谵妄。结局是 ED 就诊后 1 天内 DOSS 阳性。我们使用逻辑回归预测阿片类药物和苯二氮䓬类药物对阳性谵妄筛查的结果。
共纳入 7927 次 ED 就诊导致住院的分析。我们发现 2008 次就诊（25.3%）有阳性谵妄筛查结果。共有 3304 例（41.7%）接受了阿片类药物，1801 例（22.7%）接受了苯二氮䓬类药物。在该队列中，阿片类药物与谵妄风险增加无关（OR 1.00，95%CI 0.87-1.15）。苯二氮䓬类药物与谵妄风险增加相关（OR 1.37，95%CI 1.13-1.65），阿片类药物联合苯二氮䓬类药物也是如此（OR 1.61，95%CI 1.33-1.97）。
在这项研究中，使用苯二氮䓬类药物与谵妄风险相关。使用阿片类药物不会增加谵妄的风险。我们的研究结果表明，在 ED 中明智地使用阿片类药物进行疼痛管理可能不会增加谵妄的风险。
