Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Centre for Mental Health, University Health Network, Toronto, ON, Canada.
PLoS One. 2024 May 13;19(5):e0302888. doi: 10.1371/journal.pone.0302888. eCollection 2024.
Delirium is a major cause of preventable mortality and morbidity in hospitalized adults, but accurately determining rates of delirium remains a challenge.
To characterize and compare medical inpatients identified as having delirium using two common methods, administrative data and retrospective chart review.
We conducted a retrospective study of 3881 randomly selected internal medicine hospital admissions from six acute care hospitals in Toronto and Mississauga, Ontario, Canada. Delirium status was determined using ICD-10-CA codes from hospital administrative data and through a previously validated chart review method. Baseline sociodemographic and clinical characteristics, processes of care and outcomes were compared across those without delirium in hospital and those with delirium as determined by administrative data and chart review.
Delirium was identified in 6.3% of admissions by ICD-10-CA codes compared to 25.7% by chart review. Using chart review as the reference standard, ICD-10-CA codes for delirium had sensitivity 24.1% (95%CI: 21.5-26.8%), specificity 99.8% (95%CI: 99.5-99.9%), positive predictive value 97.6% (95%CI: 94.6-98.9%), and negative predictive value 79.2% (95%CI: 78.6-79.7%). Age over 80, male gender, and Charlson comorbidity index greater than 2 were associated with misclassification of delirium. Inpatient mortality and median costs of care were greater in patients determined to have delirium by ICD-10-CA codes (5.8% greater mortality, 95% CI: 2.0-9.5 and $6824 greater cost, 95%CI: 4713-9264) and by chart review (11.9% greater mortality, 95%CI: 9.5-14.2% and $4967 greater cost, 95%CI: 4415-5701), compared to patients without delirium.
Administrative data are specific but highly insensitive, missing most cases of delirium in hospital. Mortality and costs of care were greater for both the delirium cases that were detected and missed by administrative data. Better methods of routinely measuring delirium in hospital are needed.
谵妄是导致住院成人可预防死亡率和发病率的主要原因，但准确确定谵妄发生率仍然是一个挑战。
使用两种常见方法，即行政数据和回顾性图表审查，对患有谵妄的住院内科患者进行特征描述和比较。
我们对来自加拿大安大略省多伦多和密西沙加的六家急性护理医院的 3881 名随机选择的内科住院患者进行了回顾性研究。使用医院行政数据中的 ICD-10-CA 代码和经过验证的图表审查方法确定谵妄状态。比较无谵妄住院患者和通过行政数据和图表审查确定的谵妄患者的基线社会人口统计学和临床特征、护理过程和结局。
使用 ICD-10-CA 代码识别出 6.3%的入院患者存在谵妄，而通过图表审查识别出 25.7%的患者存在谵妄。以图表审查为参考标准，ICD-10-CA 代码诊断谵妄的敏感性为 24.1%（95%CI：21.5-26.8%），特异性为 99.8%（95%CI：99.5-99.9%），阳性预测值为 97.6%（95%CI：94.6-98.9%），阴性预测值为 79.2%（95%CI：78.6-79.7%）。80 岁以上、男性和 Charlson 合并症指数大于 2 与谵妄的误诊有关。通过 ICD-10-CA 代码确定存在谵妄的患者（死亡率增加 5.8%，95%CI：2.0-9.5%）和通过图表审查确定存在谵妄的患者（死亡率增加 11.9%，95%CI：9.5-14.2%）的住院死亡率和中位医疗费用更高，与无谵妄患者相比，前者的医疗费用增加了 6824 美元（95%CI：4713-9264），后者的医疗费用增加了 4967 美元（95%CI：4415-5701）。
行政数据具有特异性但高度不敏感，会遗漏大多数住院患者的谵妄病例。通过行政数据检测和漏诊的谵妄病例的死亡率和护理费用更高。需要更好的方法来常规测量医院中的谵妄。
