PDF(Pubmed)
Abstract：
BACKGROUND: Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10% to 50% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool.
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.
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.
摘要：
背景：谵妄，注意力不集中突出的急性混乱状态，据报道，10％至50％的COVID-19患者发生。已注意到患有COVID-19的住院患者患有或发展为谵妄和神经认知障碍。照顾谵妄患者会增加护士的负担，临床医生,和照顾者。使用电子健康记录(EHR)数据中的信息来识别谵妄和可能的COVID-19，可能会导致早期治疗潜在的病毒感染，并改善每位患者的临床和医疗保健系统成本。临床数据存储库可以通过队列识别工具进一步支持快速发现，如信息学集成生物学和床边(i2b2)工具。
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：
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：
