Department of Surgery, Arnot Ogden Medical Center, Elmira, New York.
Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania.
J Surg Res. 2024 Jan;293:89-94. doi: 10.1016/j.jss.2023.08.014. Epub 2023 Sep 19.
Delirium is associated with a three-fold increase in frequency of 6-mo mortality following intensive care unit admission. Outside of mortality, it has been linked with severe morbidity including long-term cognitive decline, loss of autonomy, and increased risk of institutionalization. There is a paucity of literature regarding delirium and geriatric trauma patients. The aim of our study is to determine predictive factors of delirium in geriatric trauma patients.
This is a retrospective review of all geriatric (>65 y) trauma patients with a documented frailty score at a Level I Trauma Center from 1/2019 to 9/2021. Univariate and multivariate logistic regressions were performed. Geriatric patients with delirium (D) and those without delirium (ND) were compared. Patients were excluded if they did not have a documented frailty score or died before admission.
One thousand three hundred and seventeen patients met criteria; 40 (3%) patients developed delirium. Neither age nor gender was different between the two groups. Frailty scores were not different between the two groups. Patients with documented delirium had a higher incidence of a positive drug screen on admission (85% versus 62.2%, P = 0.0034), higher median injury severity score (10 versus 9, P = 0.0088), and longer hospital (7 d versus 3 d, P < 0.001) and intensive care unit (1 d versus 0 d, P < 0.001) length of stay (LOS) than their ND counterparts. The D group had a higher frequency of benzodiazepine (47.5% versus 19.3%, P < 0.001) and narcotic use (77.5% versus 56.5%, P = 0.0085). Tethers nor bedrest orders were significantly associated with delirium. Incidence of urinary tract infection (12.5% versus 1%, P < 0.001) and restraint use (P < 0.001) were significantly associated with increased risk of delirium. Additionally, those with a diagnosis of delirium were more often discharged to a skilled nursing facility than those in the ND group (45% versus 30.8%, P = 0.0006).
We aimed to identify key predictive factors of delirium in our study population and found that certain factors correlated with higher frequencies of delirium in our geriatric trauma patients. Preadmission and early controlled substance use were significantly associated with delirium, as were the presence of urinary tract infection and extended intensive care unit LOS. By recognizing some of these modifiable factors, LOS may decrease while increasing the likelihood of discharge home.
在入住重症监护病房后，谵妄与 6 个月死亡率增加三倍相关。除了死亡率之外，谵妄还与严重的发病率有关，包括长期认知能力下降、丧失自主性和增加住院风险。关于老年创伤患者的谵妄，文献相对较少。我们的研究目的是确定老年创伤患者谵妄的预测因素。
这是对 2019 年 1 月至 2021 年 9 月在一级创伤中心有记录的脆弱性评分的所有老年（>65 岁）创伤患者的回顾性研究。进行了单变量和多变量逻辑回归。将有谵妄（D）的老年患者与无谵妄（ND）的老年患者进行比较。如果患者没有记录的脆弱性评分或在入院前死亡，则将其排除在外。
1317 名患者符合标准；40 名（3%）患者出现谵妄。两组之间的年龄和性别无差异。两组之间的脆弱性评分无差异。有记录的谵妄患者入院时药物筛查阳性的发生率更高（85%与 62.2%，P=0.0034），中位损伤严重程度评分更高（10 与 9，P=0.0088），住院时间更长（7 天与 3 天，P<0.001）和重症监护病房（1 天与 0 天，P<0.001）比 ND 对照组长。D 组苯二氮䓬类药物（47.5%与 19.3%，P<0.001）和阿片类药物使用率（77.5%与 56.5%，P=0.0085）更高。束缚或卧床休息医嘱与谵妄并无显著关联。尿路感染（12.5%与 1%，P<0.001）和约束使用（P<0.001）与谵妄风险增加显著相关。此外，与 ND 组相比，诊断为谵妄的患者更常被送往康复护理机构（45%与 30.8%，P=0.0006）。
我们旨在确定研究人群中谵妄的关键预测因素，发现某些因素与老年创伤患者的谵妄发生频率较高相关。入院前和早期使用管制药物与谵妄显著相关，尿路感染和延长重症监护病房住院时间也是如此。通过识别这些可改变的因素中的一些，住院时间可能会减少，同时增加出院回家的可能性。
