TY - JOUR
T1 - Riesgo de delirium durante la hospitalización en personas mayores
T2 - desarrollo y validación de un modelo de predicción clínica
AU - Carrasco G, Marcela
AU - Villarroel D, Luis
AU - Calderón P, Jorge
AU - Martínez F, Gabriel
AU - Andrade A, Maricarmen
AU - González T, Matías
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND: Delirium is a prevalent problem among older patients and it is frequently underdiagnosed.AIM: To develop and validate a clinical predictive model to identify patients at high risk of delirium.MATERIAL AND METHODS: Two consecutive prospective cohort studies were used to develop and validate the model. The development cohort included 542 consecutive medical inpatients, 65 years or older. The validation cohort included 85 comparable patients. A predictive score was constructed with a multivariate analysis, using variables independently associated with delirium and subsequently tested in the new cohort. Patients were assessed within the first 48 hours of admission, and every 48 hours thereafter, using the Confusion Assessment Method to diagnose delirium, evaluating also the severity of underlying disease, comorbidities, functionality, and laboratory data.RESULTS: Delirium occurred in 192 patients (35.4%) of the development cohort and was independently associated with age and functional status assessed using the Barthel Index. With these two variables, the predictive score for delirium was developed and tested rendering an area under the receiver operating characteristic (ROC) of 0.80 (confidence intervals 0.77-0.85). Cut-off points were chosen to establish low, intermediate, and high-risk groups for delirium. According to these cut-off points, delirium frequencies in the development cohort were 8%, 23%, and 69%, and in the validation cohort 5%, 34%, and 66%, respectively (c² p<0.05).CONCLUSIONS: This simple predictive model based on age and functional status may be a useful tool for identifying older patients risking delirium.
AB - BACKGROUND: Delirium is a prevalent problem among older patients and it is frequently underdiagnosed.AIM: To develop and validate a clinical predictive model to identify patients at high risk of delirium.MATERIAL AND METHODS: Two consecutive prospective cohort studies were used to develop and validate the model. The development cohort included 542 consecutive medical inpatients, 65 years or older. The validation cohort included 85 comparable patients. A predictive score was constructed with a multivariate analysis, using variables independently associated with delirium and subsequently tested in the new cohort. Patients were assessed within the first 48 hours of admission, and every 48 hours thereafter, using the Confusion Assessment Method to diagnose delirium, evaluating also the severity of underlying disease, comorbidities, functionality, and laboratory data.RESULTS: Delirium occurred in 192 patients (35.4%) of the development cohort and was independently associated with age and functional status assessed using the Barthel Index. With these two variables, the predictive score for delirium was developed and tested rendering an area under the receiver operating characteristic (ROC) of 0.80 (confidence intervals 0.77-0.85). Cut-off points were chosen to establish low, intermediate, and high-risk groups for delirium. According to these cut-off points, delirium frequencies in the development cohort were 8%, 23%, and 69%, and in the validation cohort 5%, 34%, and 66%, respectively (c² p<0.05).CONCLUSIONS: This simple predictive model based on age and functional status may be a useful tool for identifying older patients risking delirium.
KW - Aged
KW - Aged, 80 and over
KW - Chile/epidemiology
KW - Delirium/blood
KW - Epidemiologic Methods
KW - Female
KW - Geriatric Assessment/methods
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Male
U2 - 10.4067/S0034-98872014000700002
DO - 10.4067/S0034-98872014000700002
M3 - Article
C2 - 25378001
SN - 0034-9887
VL - 142
SP - 826
EP - 832
JO - Revista Medica de Chile
JF - Revista Medica de Chile
IS - 7
ER -