OBJECTIVE: The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes.
METHODS: We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes.
RESULTS: Less than one-third (1437/4828, 29.8%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9% (817/1437) were aged ≥65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak.
CONCLUSIONS: The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making.
目的:这项研究的具体目的是使用数据储存库调查住院老年人的谵妄作为COVID-19中可能出现的症状,以识别一组新的ICD-10代码的神经认知障碍。
方法:在本研究中,我们分析了两个人口统计学不同的集水区的数据。第一个集水区(佛罗里达州中北部的七个县)主要是农村,而第二个集水区(佛罗里达州北部的一个县)主要是城市。在2020年4月1日至2022年4月1日期间,通过医疗中心的ED查询了i2b2数据库中的COVID-19患者。COVID-19患者是通过COVID-19实验室检测结果阳性或诊断为U07.1而确定的。我们确定神经认知障碍为谵妄或脑病,使用ICD-10代码。
结果:略低于三分之一的COVID-19患者被诊断患有共同发生的神经认知障碍。在通过ED入院的所有COVID-19患者中,15.8%在入院时存在神经认知障碍(PoA)。在患有COVID-19和神经认知障碍的患者中,56.9%为65岁或以上,比例明显高于没有神经认知障碍的人。与仅诊断为谵妄以及谵妄和脑病的患者相比,仅诊断为脑病的患者中65岁以下的患者比例明显更高。在我们的研究期间,大多数通过ED入院的COVID-19患者都是在Delta变异高峰期间入院的。
结论:收集的数据表明,入院时出现神经认知障碍的老年患者感染COVID-19的数量增加。知道谵妄会增加人员配备,护理需求,医院资源使用,以及如前所述的停留时间,在规划新预期的COVID-19激增时,及早发现谵妄可能有利于医院管理。强大且可访问的数据存储库,比如这项研究中使用的,可以在这种资源重新分配和临床决策中为临床医生和临床管理人员提供宝贵的支持。
背景: