https://doi.org/10.4081/scenario.2020.450

Valutazione del delirium nell’anziano in pronto soccorso: una revisione narrativa della letteratura

Vol. 37 No. 4 (2020): SCENARIO 4 2020
Submitted: 29 January 2021
Accepted: 29 January 2021
Published: 29 January 2021
Abstract Views: 1036
PDF (Italiano): 327
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Authors

Christian Ramacciani Isermann
scenario@aniarti.it
Infermiere, Pronto soccorso ed emergenza sanitaria territoriale, Ospedale “Francesco Petruccioli”, Pitigliano (Grosseto), Azienda USL Toscana Sud Est, Italy.
Moris Rosati
Infermiere, Anestesia e Rianimazione DEA e dei Trapianti, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
Katia Marzocchi
Infermiere, Manpower Group, Italia, Italy.
Lorenzo Righi
Infermiere, Centrale operativa 118 Siena-Grosseto, Azienda USL Toscana Sud Est, Italy.
Introduzione: Il delirium è un problema tutt’altro che raro in pronto soccorso (PS): in letteratura emerge che un paziente su dieci sperimenti questa sindrome. Gli strumenti di screening propri di altri setting di cura raramente sono utilizzati in PS sia per la loro complessità che per la scarsa formazione. Anche fattori ambientali caratteristici del PS, come il sovraffollamento e l’elevato flusso di lavoro, possono contribuire a un loro ridotto utilizzo. L’obiettivo di questo lavoro, pertanto, è quello di ricercare in letteratura le evidenze più aggiornate e verificare quale metodo di valutazione, adoperabile dal personale non specialistico, sia il più efficace nell’identificare precocemente il Delirium nelle persone anziane in Pronto Soccorso. Materiali e metodi: È stata effettuata una revisione della letteratura consultando le banche dati MEDLINE (interfaccia PubMed) e CINAHL nel periodo che 13/04/2019-28/04/2019, limitando la ricerca con retroattività di 5 anni, lingua inglese o italiana e disponibilità del full text. Risultati: Negli 11 studi inclusi nella revisione sono state analizzate le scale Confusion Assessment Method (CAM), le sue versioni modificate mCAM-ED, bCAM e CAM-ICU, l’Assessment Test for delirium and cognitive impairment (4AT), la Richmond Agitation and Sedation Scale (RASS) e la sua versione “Modifiedâ€. Due lavori hanno valutato strumenti diversi dalle scale: lo screening di fragilità clinica e fattori di rischio. Conclusioni: La 4AT sembra emergere come più idonea per la valutazione del delirium in pronto soccorso: ha un tempo di somministrazione pari a 2 minuti, può essere eseguita dal personale infermieristico e mostra delle buone prestazioni diagnostiche sia in presenza che in assenza di decadimento cognitivo. Sono necessari però ulteriori studi per testarne l’utilizzo in PS, anche in comparazione con altri strumenti. Parole chiave: Delirium; Scores; Pronto Soccorso.

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Crossref
Scopus
Google Scholar
Europe PMC
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013
Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753-1762. doi:10.1001/jama.291.14.1753
Moller JT, Cluitmans P, Rasmussen LS, et al; ISPOCD Investigators. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. Lancet. 1998;351(9106):857-861. doi:10.1016/S0140-6736(97)07382-0
Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am. 2015;97(10):829-836. doi:10.2106/JBJS.N.00724
Gnerre P., Bozzano C., La Regina M. Delirium nell’anziano-Parte I: diagnosi, prevenzione, trattamento. Quaderni- Italian Journal of Medicine 2013; 1: e1.
Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA. 2017;318(12):1161–1174. doi:10.1001/jama.2017.12067.
Robinson TN, Raeburn CD, Tran ZV, et al. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249:173-178.
Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing. 2006;35:350-364.
Maldonado JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin. 2008;24:657-722.
Breitbart W, Gibson C, Tremblay A. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics. 2002;43:183-194.
Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair. JAMA Netw Open. 2019;2(2):e190111. doi:10.1001/jamanetworkopen.2019.0111.
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306. doi:10.1097/CCM.0b013e3182783b72.
Nebuloni G. Pianificare l’assistenza agli anziani nel ventunesimo secolo. Casa Editrice Ambrosiana. Quinta Edizione 2016.
Elie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F. Prevalence and detection of delirium in elderly emergency department patients. CMAJ. 2000;163(8):977–981.
Fagherazzi C., Granziera S., Brugiolo R. Il delirium nei pazienti anziani ospedalizzati in reparti internistici. G Gerontol 2015; 63:205-220.
Perèz-Ros P., Martìnez-Arnau FM. Delirium assessment in older in Emergency Department. A literature reviews. Diseases. 2019 Mar; 7(1):14.
LaMantia M., Messina FC., Hobgood CD., Miller DK. Screening for delirium in the emergency department: a systematic review. Annals of Emergency Medicine. Volume 63, Numero 5, May 2014, Pag. 551-560.
Grossman FF., Hasemann W., Graber A., Bingisser R., Kressing RW., Nickel CH. Screening, detection and management of delirium in the emergency department – a piloty study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Scand J Trauma Resusc Emerg Med. 2014 Mar 13; 22:19.
Moher D, Liberati A, Tetzlaff J, et al. Linee guida per il reporting di revisioni sistematiche e meta-analisi: il PRISMA Statement. Evidence. 2015;7(6).
Hasemann W., Grossmann FF., Stadler R., Bingisser R. et al. Screening and Detection of Delirium in Older ED Patients: Performance of the Modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A Two-Step Tool. Intern Emerg Med. 2018; 13 (6): 915-922.
Baten V., Busch HJ., Busche C., Schmid B. et al. Validation of the Brief Confusion Assessment Method for Screening Delirium in Elderly Medical Patients in a German Emergency Department. Acad Emerg Med. 2018; 25 (11): 1251-1262.
Shenkin SD., Fox C., Godfrey M., Siddiqi N., et al. Protocol for Validation of the 4AT, a Rapid Screening Tool for Delirium: A Multicentre Prospective Diagnostic Test Accuracy Study. BMJ Open. 2018; Feb 10; 8 (2): e015572.
Lucke JA., De Gelder J., Blomaard LC., Fogteloo AJ. et al. CAM-ICU May Not Be the Optimal Screening Tool for Early Delirium Screening in Older Emergency Department Patients: A Prospective Cohort Study. Eur J Emerg Med. 2019; Dec 26 (6): 428-432.
Gagné AJ., Voyer P., Boucher V., Nadeau A., et al. Performance of the French Version of the 4AT for Screening the Elderly for Delirium in the Emergency Department. CJEM. 2018; Nov 20 (6): 903-910.
Giroux M., Sirois MJ., Boucher V., Daoust R. et al. Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department. J Emerg Med. 2018; Aug 55 (2): 157-164.
Grossmann FF., Hasemann W., Kressig RW., Bingisser R. et al. Performance of the Modified Richmond Agitation Sedation Scale in Identifying Delirium in Older ED Patients. Am J Emerg Med. 2017; Sep 35 (9): 1324-1326.
Van de Meeberg EK., Festen S., Kwant M., Georg RR. et al. Improved Detection of Delirium, Implementation and Validation of the CAM-ICU in Elderly Emergency Department Patients. Eur J Med. 2017; Dec 24 (6): 411-416.
Han JH., Wilson A., Graves AJ., Shintani A. et al. A Quick and Easy Delirium Assessment for Nonphysician Research Personnel. Am J Emerg Med. 2016; Jun 34 (6): 1031-6.
Han JH., Vasilevskis EE., Schnelle JF., Shintani A. et al. The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients. Acad Emerg Med. 2015; Jul 22 (7): 878-82.
Hare M., Arendts G., Wynaden D., Leslie G. Nurse Screening for Delirium in Older Patients Attending the Emergency Department. Psychosomatics. 2014; May-Jun 55 (3): 235-42.
Singler K., Thiem U., Christ M., Zenk P. et al. Aspects and Assessment of Delirium in Old Age. First Data From a German Interdisciplinary Emergency Department. Z Gerontol Geriatr. 2014; Dec 47 (8): 650-5.
Grossmann FF., Hasemann W., Graber A., Bingisser R., Kressig RW., Nickel CH. Screening, detection and management of delirium in the emergency department—a pilot study on the feasibility of a new algorithm for use in older emergency depart-ment patients: the modifed Confusion Assessment Method for the Emergency Department (mCAM-ED). Scand J Trauma Resusc Emerg Med 2014; 22(1):1.
Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief Confusion Assessment Method. Ann Emerg Med 2013; 62:457–65.

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How to Cite

Ramacciani Isermann, C., Rosati, M., Marzocchi, K., & Righi, L. (2021). Valutazione del delirium nell’anziano in pronto soccorso: una revisione narrativa della letteratura. Scenario® - Il Nursing Nella Sopravvivenza, 37(4), 9–14. https://doi.org/10.4081/scenario.2020.450

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