Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA.
Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
BMC Psychiatry. 2022 Feb 28;22(1):151. doi: 10.1186/s12888-022-03809-2.
Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay.
In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols.
A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008).
While delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.
尽管人们认识到与 SARS-CoV-2 感染相关的神经和精神并发症，但入院时 COVID-19 的严重程度与住院患者谵妄之间的关系仍了解甚少。本研究旨在利用现有的全院系统谵妄筛查方案，测量 COVID-19 严重程度与 ICU 和急性护理患者谵妄之间的关联。次要分析包括测量年龄与谵妄之间的关联，以及谵妄与安全护理人员使用、约束使用、出院回家和住院时间之间的关联。
在这项单中心回顾性队列研究中，我们使用机构 Epic Clarity 数据库从 2020 年 2 月 1 日至 7 月 15 日获取电子病历（EMR）数据，以确定所有被诊断患有 COVID-19 并至少住院 48 小时的成年人。COVID-19 的严重程度分为四组。这些 EMR 数据包括根据现有全院协议，每天对所有患者进行两次谵妄筛查，使用护理谵妄筛查量表（非 ICU）或 CAM-ICU（ICU）。
共有 99 名患者被诊断患有 COVID-19，其中 44 名患者需要 ICU 护理，17 名患者在入院后 24 小时内符合严重疾病标准。43 名患者（43%）在住院期间的任何时候都符合谵妄标准。在有谵妄的患者中，24 名（56%）年龄在 65 岁或以下。调整后，与最低类别相比，在入院后 24 小时内符合 COVID-19 两个最高严重程度类别的患者发生谵妄的几率为 7.2 倍[调整后的优势比（aOR）7.2；95%置信区间（CI）1.9，27.4；P=0.003]。与 45 岁以下的患者相比，年龄大于 65 岁的患者发生谵妄的几率增加（aOR 8.7；95%CI 2.2，33.5；P=0.003）。谵妄与安全护理人员使用的几率增加相关（aOR 4.5；95%CI 1.0，20.7；P=0.050），出院回家的几率降低（aOR 0.2；95%CI 0.06，0.6；P=0.005），住院时间延长（aOR 7.5；95%CI 2.0，13；P=0.008）。
虽然 COVID-19 住院患者各年龄段都常见谵妄，但在入院时患有严重疾病和年龄较大的患者中更为常见。与没有谵妄的 COVID-19 患者相比，患有 COVID-19 和谵妄的患者在住院期间更需要安全护理人员，出院回家的可能性更小，住院时间更长。患有 COVID-19 的人，包括年轻患者，是进行谵妄筛查和管理的重要人群，因为谵妄与临床护理和处置方面的重要差异有关。
