Hahn Marianne, Gröschel Sonja, Gröschel Klaus, Uphaus Timo
Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,
Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Gerontology. 2023;69(3):273-281. doi: 10.1159/000526165. Epub 2022 Oct 6.
Hospitals around the world introduced considerable visitation restrictions to reduce risk of infection during epidemic spread of SARS-CoV2. Understanding of negative impacts of visitation restrictions on subgroups of patients may help to balance and adjust policies accordingly or introduce further measures to mitigate their impact. We aimed to investigate the association of visitation restrictions with delirium incidence in stroke-unit patients.
In a non-randomized observational design, data from 5,779 stroke-unit cases with transient ischemic attack or stroke (ischemic/hemorrhagic) admitted between January 2017 and November 2021 were compared between three groups depending on visitation policy implemented at time of admission: pandemic-associated absolute visitation restriction (n = 1,087), limited visitation policy (n = 862), and pre-pandemic visitation policy (n = 3,830). Univariate comparison and multiple logistic regression analyses were conducted to evaluate the association of delirium with visitation restrictions.
We observed delirium incidences of 6.3% during pandemic-associated absolute visitation restriction, 5.8% with limited visitation policy, and 5.1% with pre-pandemic visitation policy (p = 0.239). In multiple logistic regression analyses adjusting for clinically relevant variables, we found the presence of any pandemic-associated visitation restriction (odds ratio [OR] 1.363, 95% confidence interval [CI]: 1.066-1.744, p = 0.014) and specifically absolute visitation restriction (OR 1.368, 95% CI: 1.016-1.843, p = 0.039) independently associated with delirium in patients with acute cerebrovascular disease. Other factors independently associated with delirium were older age, male sex, stroke versus transient ischemic attack, acute infection, history of dementia, and longer duration of hospital stay.
Pandemic-associated visitation restrictions and specifically absolute visitation restrictions are associated with a higher incidence of delirium among stroke-unit patients with acute cerebrovascular disease. Benefit and harm of visitation restrictions should be carefully weighed and adjustments considered for patients otherwise at increased risk for delirium.
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫情传播期间，世界各地的医院都实施了严格的探视限制措施，以降低感染风险。了解探视限制对不同患者亚组的负面影响，有助于平衡和调整相应政策，或采取进一步措施减轻其影响。我们旨在研究探视限制与卒中单元患者谵妄发生率之间的关联。
采用非随机观察性设计，比较了2017年1月至2021年11月期间收治的5779例短暂性脑缺血发作或卒中（缺血性/出血性）的卒中单元病例数据，根据入院时实施的探视政策分为三组：与疫情相关的绝对探视限制组（n = 1087）、有限探视政策组（n = 862）和疫情前探视政策组（n = 3830）。进行单因素比较和多因素逻辑回归分析，以评估谵妄与探视限制之间的关联。
我们观察到，在与疫情相关的绝对探视限制期间，谵妄发生率为6.3%；有限探视政策期间为5.8%；疫情前探视政策期间为5.1%（p = 0.239）。在对临床相关变量进行调整的多因素逻辑回归分析中，我们发现，存在任何与疫情相关的探视限制（比值比[OR] 1.363，95%置信区间[CI]：1.066 - 1.744，p = 0.014），特别是绝对探视限制（OR 1.368，95% CI：1.016 - 1.843，p = 0.039）与急性脑血管疾病患者的谵妄独立相关。与谵妄独立相关的其他因素包括年龄较大、男性、卒中与短暂性脑缺血发作、急性感染、痴呆病史以及住院时间较长。
与疫情相关的探视限制，特别是绝对探视限制，与急性脑血管疾病卒中单元患者的谵妄发生率较高相关。对于谵妄风险增加的患者，应仔细权衡探视限制的利弊，并考虑进行调整。
