急诊科老年患者谵妄危险因素的系统评价

doi:10.3761/j.issn.1672-9234.2022.10.015

摘要/Abstract

摘要：

目的系统评价急诊科老年患者谵妄综合征的危险因素,为早期识别急诊科老年患者谵妄综合征的发生风险提供证据支持。方法检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、Web of Science、Cochrane Library,检索时间为建库至2021年10月6日,纳入评价急诊科老年患者谵妄综合征影响因素的观察性研究。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入25篇文献,包括17 497例急诊科患者,其中谵妄患者1 843例（10.5%）。Meta分析结果显示,急诊科老年患者谵妄的危险因素为高龄（>75岁）（OR=1.16,95%CI：1.05~1.29）、女性（OR=1.29,95%CI：1.08~1.54）、教育年限<6年（OR=2.80,95%CI：1.60~4.89）、居住在护理院（OR=3.40,95%CI：1.85~6.28）、精神状态改变（OR=13.86,95%CI：8.84~21.72）、有谵妄发作史（OR =3.85,95%CI：2.22~6.66）、衰弱（OR=1.63,95%CI：1.01~2.64）、存在认知障碍（OR=2.39,95%CI：1.14~5.01）、视力障碍（OR=2.08,95%CI：1.33~3.25）、听力障碍（OR=1.90,95%CI：1.07~3.35）、卒中或脑血管意外发作史（OR=1.70, 95%CI：1.37~2.11）、合并痴呆症（OR=5.14,95%CI：3.87~6.84）和癫痫（OR=2.69,95%CI：1.41~5.14）。文献发表偏倚不明显。结论急诊科老年患者的谵妄与多种因素有关,护理人员应早期识别谵妄综合征危险因素,及时采取个性化干预措施。

关键词: 急诊室,医院, 谵妄, 危险因素, 循证护理学

Abstract:

Objective To explore the risk factors of delirium in older adults in the Emergency Department. Methods Studies were retrieved from CNKI,VIP,SinoMed,Wanfang Database,PubMed,Web of Science,and Cochrane Library from their inception to October 6,2021. Those observational studies evaluating the influencing factors of delirium in elderly patients in the Emergency Department were included. Two investigators independently screened the studies,extracted the data and evaluated the risk of bias of the included studies,RevMan 5.3 software was used for meta-analysis. Results A total of 25 articles involving 17,497 Emergency Department patients were included,including 1,843 patients（10.5%） with delirium. Meta-analysis showed that the risk factors for delirium in elderly patients in the Emergency Department were advanced age（>75）（OR=1.16,95%CI：1.05~1.29）,female gender（OR=1.29,95%CI：1.08~1.54）,years of education<6 years（OR=2.80,95%CI：1.60~4.89）,living in a nursing home（OR= 3.40,95%CI：1.85~6.28）,altered mental status（OR=13.86,95%CI：8.84~21.72）,history of delirium attacks（OR= 3.85,95%CI：2.22~6.66）,frailty（OR=1.63,95%CI：1.01~2.64）,presence of cognitive impairment（OR=2.39,95%CI：1.14~5.01）,visual impairment（OR=2.08,95%CI：1.33~3.25）,hearing impairment（OR=1.90,95%CI：1.07~3.35）,stroke or history of cerebrovascular accident（OR=1.70,95%CI：1.37~2.11）,combined dementia（OR=5.14,95%CI：3.87~6.84） and epilepsy（OR=2.69,95%CI：1.41~5.14）. The publication bias of the study was not significant. Conclusion Delirium in elderly patients in the Emergency Department is associated with a variety of factors,and early identification of delirium syndrome risk factors by nursing staff and implement individualized intervention timely.

Key words: Emergency Service,Hospital, Delirium, Risk Factors, Evidence-Based Nursing

白光英,李玉华,孙晓. 急诊科老年患者谵妄危险因素的系统评价[J]. 中华护理教育, 2022, 19(10): 944-949.

BAI Guangying,LI Yuhua,SUN Xiao. A systematic review of the risk factors of delirium in older adults in the Emergency Department[J]. Chinese Journal of Nursing Education, 2022, 19(10): 944-949.

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参考文献 35

[1]	Faiad Y, Khoury B, Daouk S, et al. Frequency of use of the International Classification of Diseases ICD-10 diagnostic categories for mental and behavioural disorders across world regions[J]. Epidemiol Psychiatr Sci, 2018, 27(6):568-576. doi: 10.1017/S2045796017000683
[2]	Boucher V, Lamontagne ME, Nadeau A, et al. Unrecognized incident delirium in older emergency department patients[J]. J Emerg Med, 2019, 57(4):535-542. doi: S0736-4679(19)30419-6 pmid: 31353267
[3]	Han JH, Vasilevskis EE, Chandrasekhar R, et al. Delirium in the emergency department and its extension into hospitalization (DELINEATE) study:effect on 6-month function and cognition[J]. J Am Geriatr Soc, 2017, 65(6):1333-1338. doi: 10.1111/jgs.14824
[4]	Goldberg TE, Chen C, Wang YJ, et al. Association of delirium with long-term cognitive decline:a meta-analysis[J]. JAMA Neurol, 2020, 77(11):1373-1381. doi: 10.1001/jamaneurol.2020.2273
[5]	Davis DHJ, Muniz-Terrera G, Keage HAD, et al. Association of delirium with cognitive decline in late life:a neuropathologic study of 3 population-based cohort studies[J]. JAMA Psychiatry, 2017, 74(3):244-251. doi: 10.1001/jamapsychiatry.2016.3423
[6]	Gao Y, Gao RQ, Yang RQ, et al. Prevalence,risk factors,and outcomes of subsyndromal delirium in older adults in hospital or long-term care settings:a systematic review and meta-analysis[J]. Geriatr Nurs, 2022, 45:9-17. doi: 10.1016/j.gerinurse.2022.02.021 pmid: 35286871
[7]	Guthrie PF, Rayborn S, Butcher HK. Evidence-based practice guideline:delirium[J]. J Gerontol Nurs, 2018, 44(2):14-24. doi: 10.3928/00989134-20180110-04
[8]	Israni J, Lesser A, Kent T, et al. Delirium as a predictor of mortality in US Medicare beneficiaries discharged from the emergency department:a national claims-level analysis up to 12 months[J]. BMJ Open, 2018, 8(5):e021258. doi: 10.1136/bmjopen-2017-021258
[9]	Béland E, Nadeau A, Carmichael PH, et al. Predictors of delirium in older patients at the emergency department:a prospective multicentre derivation study[J]. CJEM, 2021, 23(3):330-336. doi: 10.1007/s43678-020-00004-8
[10]	Mailhot T, Darling C, Ela J, et al. Family identification of de-lirium in the emergency department in patients with and without dementia:validity of the family confusion assessment me-thod(FAM-CAM)[J]. J Am Geriatr Soc, 2020, 68(5):983-990. doi: 10.1111/jgs.16438 pmid: 32274799
[11]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research—The quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[12]	Rostom A, Dube C, Cranney A, et al. Celiac Disease. Rock-ville(MD):agency for healthcare research and quality[EB/OL]. [2021-12-02]. http://www.ncbi.nlm.nih.Gov/books/NBK35156.
[13]	Kennedy M, Enander RA, Tadiri SP, et al. Delirium risk prediction,healthcare use and mortality of elderly adults in the emergency department[J]. J Am Geriatr Soc, 2014, 62(3):462-469. doi: 10.1111/jgs.12692 pmid: 24512171
[14]	Elie M, Rousseau F, Cole M, et al. Prevalence and detection of delirium in elderly emergency department patients[J]. CMAJ, 2000, 163(8):977-981.
[15]	Han JH, Zimmerman EE, Cutler N, et al. Delirium in older emergency department patients:recognition,risk factors,and psychomotor subtypes[J]. Acad Emerg Med, 2009, 16(3):193-200. doi: 10.1111/j.1553-2712.2008.00339.x
[16]	Ohl ICB, Chavaglia SRR, Ohl RIB, et al. Evaluation of delirium in aged patients assisted at emergency hospital service[J]. Rev Bras Enferm, 2019, 72(suppl 2):153-160. doi: S0034-71672019000800153 pmid: 31826205
[17]	Ramirez-Bermudez J, Lopez-Gómez M, Sosa Ana L, et al. Frequency of delirium in a neurological emergency room[J]. J Neu-ropsychiatry Clin Neurosci, 2006, 18(1):108-112.
[18]	Rizzi MA, Torres Bonafonte OH, Alquezar A, et al. Prognostic value and risk factors of delirium in emergency patients with decompensated heart failure[J]. J Am Med Dir Assoc, 2015, 16(9):799.e1-799.e6.
[19]	Thompson C, Brienza VJM, Sandre A, et al. Risk factors associated with acute in-hospital delirium for patients diagnosed with a hip fracture in the emergency department[J]. CJEM, 2018, 20(6):911-919. doi: 10.1017/cem.2018.427
[20]	Ritter SRF, Cardoso AF, Lins MMP, et al. Underdiagnosis of delirium in the elderly in acute care hospital settings:lessons not learned[J]. Psychogeriatrics, 2018, 18(4):268-275. doi: 10.1111/psyg.12324
[21]	Nguyen PVQ, Pelletier L, Payot I, et al. The Delirium Drug Scale is associated to delirium incidence in the emergency department[J]. Int Psychogeriatr, 2018, 30(4):503-510. doi: 10.1017/S1041610217002538
[22]	Han JH, Morandi A, Ely EW, et al. Delirium in the nursing home patients seen in the emergency department[J]. J Am Geriatr Soc, 2009, 57(5):889-894. doi: 10.1111/j.1532-5415.2009.02219.x pmid: 19484845
[23]	Kennedy M, Helfand BKI, Gou RY, et al. Delirium in older patients with COVID-19 presenting to the emergency department[J]. JAMA Netw Open, 2020, 3(11):e2029540. doi: 10.1001/jamanetworkopen.2020.29540
[24]	Daoust R, Paquet J, Boucher V, et al. Relationship between pain,opioid treatment,and delirium in older emergency department patients[J]. Acad Emerg Med, 2020, 27(8):708-716. doi: 10.1111/acem.14033
[25]	Cirbus J, MacLullich AMJ, Noel C, et al. Delirium etiology sub-types and their effect on six-month function and cognition in older emergency department patients[J]. Int Psychogeriatr, 2019, 31(2):267-276. doi: 10.1017/S1041610218000777 pmid: 30021661
[26]	Fallon A, Kilbane L, Briggs R, et al. Screening for frailty in older emergency department patients:the utility of the Survey of Health,Ageing and Retirement in Europe Frailty Instrument[J]. QJM, 2018, 111(3):151-154. doi: 10.1093/qjmed/hcx242 pmid: 29237068
[27]	Evensen S, Saltvedt I, Lydersen S, et al. Environmental factors and risk of delirium in geriatric patients:an observational study[J]. BMC Geriatr, 2018, 18(1):282. doi: 10.1186/s12877-018-0977-y pmid: 30442109
[28]	Han JH, Brummel NE, Chandrasekhar R, et al. Exploring de-lirium’s heterogeneity:association between arousal subtypes at initial presentation and 6-month mortality in older emergency department patients[J]. Am J Geriatr Psychiatry, 2017, 25(3):233-242. doi: 10.1016/j.jagp.2016.05.016
[29]	émond M, Grenier D, Morin J, et al. Emergency department stay associated delirium in older patients[J]. Can Geriatr J, 2017, 20(1):10-14.
[30]	Sri-On J, Tirrell GP, Vanichkulbodee A, et al. The prevalence,risk factors and short-term outcomes of delirium in Thai elderly emergency department patients[J]. Emerg Med J, 2016, 33(1):17-22.
[31]	Bo M, Bonetto M, Bottignole G, et al. Length of stay in the emer-gency department and occurrence of delirium in older medical patients[J]. J Am Geriatr Soc, 2016, 64(5):1114-1119. doi: 10.1111/jgs.14103
[32]	Han JH, Shintani A, Eden S, et al. Delirium in the emergency department:an independent predictor of death within 6 months[J]. Ann Emerg Med, 2010, 56(3):244-252.e1. doi: 10.1016/j.annemergmed.2010.03.003
[33]	Bo M, Martini B, Ruatta C, et al. Geriatric ward hospitalization reduced incidence delirium among older medical inpatients[J]. Am J Geriatr Psychiatry, 2009, 17(9):760-768. pmid: 19705520
[34]	Kakuma R, du Fort GG, Arsenault L, et al. Delirium in older emergency department patients discharged home:effect on survival[J]. J Am Geriatr Soc, 2003, 51(4):443-450. doi: 10.1046/j.1532-5415.2003.51151.x
[35]	Mattison MLP. Delirium[J]. Ann Intern Med, 2020, 173(7):ITC49-ITC64. doi: 10.7326/AITC202010060 pmid: 33017552