谵妄：我们完全认识它吗

Title: Delirium - are we really looking for it?
题目：谵妄：我们完全认识它吗？
Author 作者: Danya Khoujah
翻译：陈都 校对：肖锋

Delirium has long been recognized as a common disorder of the geriatric ED population (seen in up to 20% of patients above the age of 65 years), but how good are we at detecting it?
谵妄长期以来被看作是老年急诊患者的常见症状（65岁以上的患者中比例高达20%以上）。但是我们在发现这类患者的过程中做的如何呢？

Studies show that the diagnosis of delirium is made in the ED in only 11-46% of patients, which means that more than half go undiagnosed. The problem is, the risk of death at 3 months increases by 11% for every 48 hours of delirium the patient experiences, and so does their length of stay and functional decline. It is mostly missed in patients who have a baseline cognitive dysfunction, such as dementia.
研究显示在急诊诊断谵妄的人群仅占到患者比例的11%-46%，这意味着超过半数的被漏诊。问题是患者每次谵妄发作48小时其三个月死亡风险增加11%，他们的住院时间及认知功能下降亦是如此。对于合并基础认知功能不全的患者如痴呆患者，更容易漏诊。

So what can we do about that?
那么，我们应该如何做哪？

Treat delirium as a neurolgical emergency; be vigilant about diagnosing it and treating it. There are a lot of neurocognitive tests that can be used for diagnosis (such as the mini-mental status exam), but they are usually too cumbersome to use in an ED setting. The CAM (Confusion Assessment Method) has been extensively studied and has a sensitivity and specifity of about 95% to diagnose delirium. It includes the acuity of onset, fluctuant course, inattention (the hallmark), disorganized thinking and/or altered level of consciousness.
把谵妄作为神经急症来处理，对其诊断和治疗我们应该保持警惕。有很多的神经认知检测可用于其诊断（如快速精神状态测试），但是他们用在急诊显得过于繁琐。CAM(精神混乱评估法)历经了广泛的研究，诊断谵妄具有约95%的灵敏度和特异度。包括发作的剧烈程度，波动过程，注意力不集中（标志），思维紊乱、意识水平的改变。

Bottom Line? Don't forget to screen your elderly patients for delirium and treat them accordingly!
要点：对于老年患者不要忘了做谵妄筛查并采取相应的治疗。

References 参考文献
1. Wilber ST, Han JH. Altered Mental Status in the Elderly. Geriatric Emergency Medicine Principles and Practice. Edited by Kahn JH, Maguaran Jr BG, Olshaker JS. New York: Cambridge University Press; 2014: 102-113
2. Barron EA, Holmes J. Delirium within the emergency Care setting, occurence and detection: a systematic review. EMJ 2013; 30(4) 263-268
3. Wei LA, BA, Fearing MA et al. The Confusion Assessment Method: A Systematic Review of Current Usage J Am Geriatr Soc 56:823–830, 2008