Pompei P, Foreman M, Rudberg M A, Inouye S K, Braund V, Cassel C K
University of Chicago, Illinois.
J Am Geriatr Soc. 1994 Aug;42(8):809-15. doi: 10.1111/j.1532-5415.1994.tb06551.x.
The purpose of this study was fourfold; to determine the rate of delirium among hospitalized older persons, to contrast the clinical outcomes of patients with and without delirium, to identify clinical predictors of delirium, and to validate the predictive model in an independent sample of patients.
Two prospective cohort studies
Medical and surgical wards of 2 university teaching hospitals.
In the derivation cohort, 432 patients were enrolled from the University of Chicago Hospitals. Patients 65 years of age or older admitted to 1 of 4 wards were eligible. Subjects were excluded if they were discharged within 48 hours of admission, unavailable to the research assistants during the first 2 days of hospitalization, or judged too impaired to participate in the daily interviews. In the test cohort, 323 patients 70 years of age or older admitted to Yale-New Haven Hospital were studied.
Subjects were screened for delirium daily and referred to experienced clinician investigators if acute mental status changes were observed. The clinician investigators assessed the patient for delirium based on DSM-III-R criteria. Duration of hospitalization was adjusted for diagnosis-related groups (DRG) and mortality rates were determined at discharge and 90 days after discharge. Sociodemographic characteristics, cognitive and functional status, comorbidity, depression, and alcoholism were examined as predictors of delirium.
The rate of delirium in the derivation cohort was 15%; subjects with delirium had longer hospital stays and an increased risk of in-hospital death. Cognitive impairment, burden of comorbidity, depression, and alcoholism were found to be independent predictors of delirium. The ability of the model to stratify patients as low, moderate, or high risk for developing delirium was validated in the test cohort in which the rate of delirium was 26%.
This study confirms the high rate of delirium among hospitalized older persons and the associated adverse outcomes of prolonged hospital stays and increased risk of death. Patients can be stratified according to their risk for developing delirium using relatively few clinical characteristics which should be assessed, on all hospitalized older persons.
本研究有四个目的；确定住院老年人谵妄的发生率，对比有谵妄和无谵妄患者的临床结局，识别谵妄的临床预测因素，并在独立的患者样本中验证预测模型。
两项前瞻性队列研究
两所大学教学医院的内科和外科病房。
在推导队列中，从芝加哥大学医院招募了432名患者。入住4个病房之一的65岁及以上患者符合条件。如果患者在入院后48小时内出院、在住院的前两天研究助理无法接触到他们，或被判定身体过于虚弱无法参与每日访谈，则将其排除。在测试队列中，对耶鲁-纽黑文医院收治的323名70岁及以上患者进行了研究。
每天对受试者进行谵妄筛查，如果观察到急性精神状态变化，则转介给经验丰富的临床研究人员。临床研究人员根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）标准对患者进行谵妄评估。根据诊断相关组（DRG）调整住院时间，并在出院时和出院后90天确定死亡率。将社会人口学特征、认知和功能状态、合并症、抑郁症和酗酒作为谵妄的预测因素进行检查。
推导队列中谵妄的发生率为15%；有谵妄的受试者住院时间更长，院内死亡风险增加。发现认知障碍、合并症负担、抑郁症和酗酒是谵妄的独立预测因素。该模型将患者分为发生谵妄的低、中、高风险的能力在测试队列中得到验证，该队列中谵妄的发生率为26%。
本研究证实住院老年人中谵妄的发生率很高，以及与之相关的住院时间延长和死亡风险增加的不良结局。可以使用相对较少的临床特征对患者发生谵妄的风险进行分层，应对所有住院老年人进行这些特征的评估。
