| ObjectivesDescribe the current situation of subsyndromal delirium in patients with emergency trauma surgery,explore the high-risk factors of subsyndromal delirium in trauma patients,build a predictive model for the occurrence of subsyndromal delirium,and quickly identify subsyndromal delirium for nursing staff,and further develop nursing intervention measures to reduce the occurrence of subsyndromal delirium and improve the prognosis of patients after emergency trauma to provide theoretical basis and practical guidance.MethodsThis study was an observational study.A total of 306 patients admitted to the emergency trauma care unit of a Grade III,Grade A general hospital in Shandong Province from January to December 2020 were selected as the subjects.The assessment tools included the Patient General Data Questionnaire,the Second Acute Physiological and Chronic Health Rating Scale（APACH Ⅱ）,the Digital Pain Assessment Tool（NRS）,the ICU Environmental Stressors Scale（ICUESS）,the Hamilton Anxiety Scale（HAMA）,and the ICDSC Screening Scale for Critical Care Delirium.SPSS20.0 was used to input data and analyze,and the statistical methods included:Independent sample t-test,chi-square test,Mann-Whitney U test,and multivariate Logistic regression analysis were used to describe the influencing factors of subsyndromal delirium occurrence in trauma patients.The receiver operating characteristic curve（ROC curve）was used to describe the prediction model and the efficacy of each risk factor in predicting subsyndromal delirium occurrence.Results1.A total of 306 patients were investigated in this study,ranging from 20 to 98 years old,with an average of 53.4±15.6 years old.Traffic accident inju ry was the most common cause of injury,with 204 cases（66.4%）,followed b y falling injury in 55 cases（18.0%）.Subsyndromal delirium occurred in 98 of the 306 patients,and the incidence of subsyndromal delirium was 32.0%.The total score of the ICDSC scale ranged from 1to3 as subsyndromal delirium,a mong which 14 patients（14.3%）received 1,32 patients（32.7%）received 2,a nd 52 patients（53.1%）received 3.The most frequent symptom in the ICDSC scale was the disorder of sleep and wake cycle,followed by inattention.2.Univariate analysis showed that:Age,ISS score,APACH Ⅱ were observed in patients with no delirium group and subsyndromal delirium group Ratings,living care whether time,operation time,perioperative blood transfusion,whether mechanical ventilation,postoperative NRS score,whether physical constraints,arterial blood oxygen partial pressure on admission to hospital,HCT,HGB,BUN,and environmental stressors scale dimension scores of the physical environment,the humane environment in the dimension scores,treatment environment dimension score,their feelings dimension scores,and Hamilton There was a significant difference in total anxiety score（P<0.05）.3.Logistic regression analysis showed that:Age（OR=1.151）,APACH Ⅱ score（OR=1.314）,length of stay in the ICU（OR=1.881）,operative time（OR=1.976）,postoperative NRS score（OR=4.314）,the total score of human-environment dimension（OR=1.349）and total score of self-perception dimension（OR=1.413）were independent risk factors for subsyndromal delirium in trauma patients.4.The analysis of the subject characteristic curve showed that the area un der the curve（AUC）of the predicted subdelusion model was 0.991,95%CI（0.983,0.999）,and the sensitivity and specificity of the model were 0.980 and 0.957,respectively.2,X2=4.156 and P=0.843.The results of the Hosmer-Lemeshow test of the model showed its X2=4.156 and P=0.843.The area under the curve of age,APACH Ⅱ score,duration of stay in the intensive care unit,operation time,postoperative NRS score,the total score of human-environment dimensio n and total score of self-feeling dimension were 0.655、0.695、0.877、0.621、0.687、0.933、0.941,respectively.The corresponding maximum truncation value（s ensitivity,specificity）was40.5（0.980,0.564）,8.5（0.592,0.761）,3.5（0.837,0.774）,5.04（0.306,0.938）,3.5（0.612,0.663）,20.5（0.990,0.856）,20.5（0.959,0.827）.5.There were statistically significant differences in mechanical ventilation time（Z=-2.123,P=0.034）,length of stay in ICU（Z=-10.881,P<0.001）,total length of stay（Z=-4.898,P<0.001）,pneumonia（X2=23.860,P<0.001）,and deep venous thrombosis of lower limbs（X2=5.495,P<0.001）between patients with and without subsyndromal delirium.Conclusions1.The incidence of delirium in surgical patients in the emergency trauma care ward is 32.0%,which suggests that nursing staff should strengthen the identification and predictive judgment of delirium in clinical work,take relevant intervention measures in advance,reduce or avoid the occurrence of delirium and the further development of delirium,and reduce the harm to patients.2.The older the patient,the higher the APACH Ⅱ score,the longer stay i n the intensive care unit,the longer the operation time,the heavier postoperati ve pain,the greater the perception of environmental pressure in the human env ironment,and their feelings,are more likely to develop subsyndromal delirium.The subsyndromal delirium prediction model has a higher predictive value.In clinical nursing work,this prediction model can be used to identify patients wi th high risk of sub delirium.Early assessment and accurate intervention can re duce the risk of sub delirium and improve the management level of patients w ith severe trauma.3.Subsyndromal delirium is easy to cause prolonged mechanical ventilatio n time,prolonged ICU stay and increased complications.Therefore,early identi fication of subsyndromal delirium and intervention measures can help reduce th e risk of occurrence and progress of subsyndromal delirium improve prognosis,reduce medical costs and improve quality of life. |
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