Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

BMC Geriatrics

Research Article

Jennifer K. Burton¹  Zoë Tieges²  Alasdair M. J. MacLullich²  Susan D. Shenkin²  David J. Stott³  Amy Todd⁴  Samantha Blackley⁴  E. Wesley Ely⁵ 

[1] Alzheimer Scotland Dementia Research Centre, Edinburgh, Scotland;Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland;Edinburgh Delirium Research Group, Geriatric Medicine, Edinburgh University, Edinburgh, Scotland;Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland;Edinburgh Delirium Research Group, Geriatric Medicine, Edinburgh University, Edinburgh, Scotland;Institute of Cardiovascular and Medical Sciences University of Glasgow, Glasgow, Scotland;Medicine of the Elderly, NHS Lothian, Royal Infirmary, Edinburgh, Scotland;Tennessee Valley Veteran’s Affairs Geriatric Research Education and Clinical Centre (GRECC), Nashville, TN, USA;Vanderbilt University Medical Centre, Nashville, TN, USA;

关键词: Mortality;    Altered mental status;    Delirium;    Systematic review;    Glasgow Coma Scale;   

DOI  :  10.1186/s12877-017-0661-7

 received in 2017-07-12, accepted in 2017-11-09,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundReduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality.MethodsWe conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model.ResultsFrom 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias).ConclusionsReduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.

【 授权许可】

CC BY   
© The Author(s). 2017