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Delirium developed in 27 of 107 patients(25%)in the development cohort. Four independent baseline risk factors for delirium were identified using proportional hazards analysis:these included vision impairment(adjusted relative risk,3.5;95%CI,1.2 to 10.7);severe illness(relative risk,3.5;CI, 1.5 to 8.2);cognitive impairment(relative risk,2.8;CI,1.2 to 6.7);and a high blood urea nitrogen/creatinine ratio(relative risk,2.0;CI,0.9 to 4. 6).A risk stratification system was developed by assigning 1 point for each risk factor present.Rates of delirium for low-(0 points), intermediate-(1 to 2 points),and high-risk(3 to 4 points)groups were 9%, 23%,and 83%(P<0.0001),respectively.The corresponding rates in the validation cohort,in which 29 of 174 patients(17%)developed delirium,were 3%,16%,and 32%(P<0.002).The rates of death or nursing home placement, outcomes potentially related to delirium,were 9%,16%,and 42%(P=0.02)in the development cohort and 3%,14%,and 26%(P=0.007)in the validation cohort. Delirium among elderly hospitalized patients is common,and a simple predictive model based on four risk factors can be used at admission to identify elderly persons at the greatest risk. |
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