Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

被引：6

作者：

Yadav, Krishan ^{[1
]}

Boucher, Valerie ^{[2
,3
,4
,5
]}

Carmichael, Pierre-Hugues ^{[3
]}

Voyer, Philippe ^{[2
,3
,6
]}

Eagles, Debra ^{[7
,8
]}

Pelletier, Mathieu ^{[9
]}

Gouin, Emilie ^{[10
,11
]}

Daoust, Raoul ^{[12
,13
,14
]}

Thien Tuong Minh Vu ^{[13
,15
]}

Berthelot, Simon ^{[4
,5
,16
]}

Emond, Marcel ^{[2
,3
,4
,5
,16
]}

机构：

[1] Univ Laval, Quebec City, PQ, Canada

[2] Univ Laval, Ctr Rech Soins & Serv Premiere Ligne, Quebec City, PQ, Canada

[3] Ctr Excellence Vieillissement Quebec, Quebec City, PQ, Canada

[4] Univ Laval, Fac Med, Quebec City, PQ, Canada

[5] Univ Laval, Axe Sante Populat & Prat Optimales Sante, Ctr Rech, CHU Quebec, Quebec City, PQ, Canada

[6] Univ Laval, Fac Sci Infirm, Quebec City, PQ, Canada

[7] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada

[8] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[9] Ctr Integre Sante & Serv Sociaux Lanaudiere, Joliette, PQ, Canada

[10] Ctr Hosp Reg Trois Rivieres, Trois Rivieres, PQ, Canada

[11] CIUSSS, Trois Rivieres, PQ, Canada

[12] Hop Sacre Coeur Montreal, Ctr Rech, Montreal, PQ, Canada

[13] Univ Montreal, Fac Med, Montreal, PQ, Canada

[14] Hop Sacre Coeur Montreal, Dept Med Urgence, Montreal, PQ, Canada

[15] Ctr Hosp Univ Montreal, Ctr Rech, Montreal, PQ, Canada

[16] Univ Laval, Dept Med Urgence, CHU Quebec, Quebec City, PQ, Canada

来源：

AGE AND AGEING | 2020年 / 49卷 / 01期

关键词：

older people; delirium; emergency department; detection; CONFUSION ASSESSMENT METHOD; RECOGNITION; VALIDATION; COGNITION;

D O I：

10.1093/ageing/afz144

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Background: delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives: to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design: a prospective observational multicenter cohort study. Setting: four Quebec EDs. Participants: independent or semi-independent older patients (age >= 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements: eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results: we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval-CI 69.3-96.2%) and a specificity of 44.3% (95%; CI 38.3-50.4%). Conclusion: serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

引用

页码：130 / 134

页数：5

共 26 条

[1]

Affleck A, 2013, CAN J EMERG MED, V15, P359

[2] Diagnostic accuracy of the Ottawa 3DY and Short Blessed Test to detect cognitive dysfunction in geriatric patients presenting to the emergency department [J].