谵妄患者和无谵妄患者的神经学诊断测试:一项前瞻性观察研究。

IF 5.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY
GeroScience Pub Date : 2024-12-01 Epub Date: 2024-06-25 DOI:10.1007/s11357-024-01246-5
Noémie Waefler, Imen Abid, Victor Montaut, Jacques Donzé, Hervé Zender, Gregor John
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引用次数: 0

摘要

由于谵妄的大多数诱发因素并非神经系统疾病所致,因此神经系统诊断测试(NDT)的价值可能有限。我们推测,谵妄的神经诊断测试负担很重,但诊断率却很低。2019年11月至2020年1月期间入住一家二级教学医院内科病房的所有患者均符合条件。在入院后的 48 小时内,他们接受了神经心理学家的正式评估,以筛查是否存在谵妄。采用倾向性评分分层的逻辑回归模型,对住院期间进行的无损检测(脑磁共振成像、脑CT、脑电图和腰椎穿刺)在有谵妄和无谵妄患者之间进行了比较。比较了每种检查的诊断率(改变治疗方案的急性异常)。在纳入的 217 例患者中,19/32 例(61%)有谵妄的患者进行了一次或多次无损检测,而 48/185 例(26%)无谵妄的患者进行了一次或多次无损检测(调整 OR 2.7;95%CI 1.1-6.7;p = 0.027)。在有谵妄和无谵妄患者中,影响管理的无损检测结果比例分别为:脑 CT 扫描 13% 和 20%(p = 0.71),脑 MRI 29% 和 38%(p = 0.99),脑电图 20% 和 10%(p = 0.99)。对谵妄患者进行无损检测的比例较高,但诊断率较低,尽管与无谵妄住院患者进行的无损检测在统计学上没有差异。有必要制定以证据为基础的限制性指南,以帮助对谵妄患者进行检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Neurological diagnostic tests for patients with and without delirium: a prospective observational study.

Neurological diagnostic tests for patients with and without delirium: a prospective observational study.

Since most of the precipitating factors of delirium are not due to neurological disorders, neurological diagnostic tests (NDTs) may be of limited value. We hypothesized that delirium has a high burden of NDTs with a low diagnostic yield. All patients admitted to the internal medicine wards of a single secondary teaching hospital between November 2019 and January 2020 were eligible. Within the first 48 h of their admission, they had a formal evaluation by a neuropsychologist to screen for presence of delirium. NDTs (brain MRI, brain CT, electroencephalography (EEG), and lumbar puncture) performed during the hospital stay were compared between patients with and without delirium using a logistic regression model stratified by a propensity score. The proportions of diagnostic yield (acute anomalies that changed the treatment management) provided by each type of examination were compared. Of 217 patients included, 19/32 patients (61%) with delirium had one or more NDTs, compared to 48/185 (26%) without delirium (adjusted OR 2.7; 95%CI 1.1-6.7; p = 0.027). The proportions of NDT results affecting management for patients with and without delirium were 13 and 20% for brain CT scans (p = 0.71), 29 and 38% for brain MRI (p = 0.99), and 20 and 10% for EEGs (p = 0.99), respectively. The higher proportion of NDTs performed on patients with delirium was associated with a low diagnostic yield, although not statistically different from those performed among inpatients without delirium. There is a need for restrictive, evidence-based guidelines to help with the work-up for patients with delirium.

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来源期刊
GeroScience
GeroScience Medicine-Complementary and Alternative Medicine
CiteScore
10.50
自引率
5.40%
发文量
182
期刊介绍: GeroScience is a bi-monthly, international, peer-reviewed journal that publishes articles related to research in the biology of aging and research on biomedical applications that impact aging. The scope of articles to be considered include evolutionary biology, biophysics, genetics, genomics, proteomics, molecular biology, cell biology, biochemistry, endocrinology, immunology, physiology, pharmacology, neuroscience, and psychology.
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