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Duan R, Cao L, Zhang H, Li P, Wu X, Li J. The effect of fascia iliaca compartment block on postoperative delirium in elder adults undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Orthop Trauma Nurs 2024; 54:101122. [PMID: 39047334 DOI: 10.1016/j.ijotn.2024.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/01/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate whether fascia iliaca compartment block (FIB) could reduce the incidence of postoperative delirium (POD) in elderly patients undergoing hip surgery. METHODS This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023490399). The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) till November 15, 2023. Review Manger 5.4 was used to analyze the data. RESULTS A total of 10 RCTs with 930 elderly patients were included in this meta-analysis. This meta-analysis indicated that FIB could reduce the incidence of POD in elderly patients undergoing hip surgery without preoperative cognitive impairment (OR:0.46; 95%CI[0.22, 0.96], P = 0.04, I2 = 0%). Subgroup analysis of the incidence of POD showed that elderly patients who received FIB treatment before entering the operating room had a lower risk of developing POD(OR:0.48; 95%CI[0.30, 0.76], P = 0.002, I2 = 0%), and FIB could reduce the occurrence of POD in patients undergoing intravertebral anesthesia instead of general anesthesia (OR:0.37; 95%CI[0.20, 0.66], P﹤0.01, I2 = 0%). Moreover, FIB could reduce the MMSE score on the first day after surgery (SMD:1.07; 95%CI[0.15, 1.99], P = 0.02, I2 = 86%). In addition, FIB could reduce the pain score on the first and third day after surgery (SMD: -0.46; 95%CI[-0.74, -0.18], P = 0.001, I2 = 43%; SMD: -0.62; 95%CI[-0.97, -0.26], P﹤0.001, I2 = 58%), as well as after physical activity(SMD: -1.64; 95%CI[-3.00, -0.28], P = 0.02, I2 = 83%). CONCLUSION FIB can reduce the incidence of POD in elderly patients undergoing hip surgery without pre-existing cognitive impairment. Additionally, it can lower the delirium scores and pain scores.
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Affiliation(s)
- Ran Duan
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Longlu Cao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoqian Wu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China.
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Huaguo Y, Kang S, Hu L, Zhou H. Advancing pain management for extremity trauma: the evolution of ultrasound-guided nerve blocks for patients in the supine position in trauma centers. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02523-w. [PMID: 38649528 DOI: 10.1007/s00068-024-02523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Trauma, particularly extremity trauma, poses a considerable challenge in healthcare, especially among young adults. Given the severity of patient pain and the risks associated with excessive opioid use, managing acute pain in trauma centers is inherently complex. This study aims to investigate the application and benefits of ultrasound-guided nerve blocks for early pain management in patients with extremity trauma positioned supine. METHODS A comprehensive literature review was conducted to assess the effectiveness and advantages of ultrasound-guided peripheral nerve blocks in the acute pain management of extremity trauma patients in the supine position. Special emphasis was placed on evaluating the selection criteria, indications, contraindications, adverse reactions, and potential complications associated with these nerve block techniques. RESULTS Ultrasound-guided nerve blocks represent a safer and more precise option for managing pain in extremity trauma patients placed in the supine position. These techniques offer significant advantages in terms of reducing healthcare expenses, diminishing reliance on opioid medications, and mitigating opioid-related complications. Nonetheless, challenges may arise due to the necessity for patient cooperation during specific nerve block procedures. CONCLUSION Ultrasound-guided nerve blocks present a promising avenue for early pain management in extremity trauma patients positioned supinely. Their implementation can lead to improved patient outcomes by alleviating pain severity, reducing opioid consumption, and cutting down healthcare costs. Further research and clinical integration of these techniques is imperative to enhance pain management protocols in trauma centers.
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Affiliation(s)
- Yuefeng Huaguo
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China
| | - Shuai Kang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China
| | - Li Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China.
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China.
| | - Hongmei Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China.
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China.
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Ulrich G, Kraus K, Polk S, Zuelzer D, Matuszewski PE. Implementation of a Fascia Iliaca Compartment Block Program in Geriatric Hip Fractures: The Experience at a Level I Academic Trauma Center. J Orthop Trauma 2024; 38:96-101. [PMID: 37941115 DOI: 10.1097/bot.0000000000002722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Determine adherence to a newly implemented protocol of fascia iliaca compartment block (FICB) in geriatric hip fractures. METHODS DESIGN Retrospective review. SETTING Level I trauma center. PATIENT SELECTION CRITERIA Patients with a hip fracture treated with cephalomedullary nailing or hemiarthroplasty (CPT codes 27245 or 27236). OUTCOME MEASURES AND COMPARISONS Adherence to a protocol for FICB, time intervals between emergency department arrival, FICB, and surgery stratified by time of admission. RESULTS Three hundred eighty patients were studied (average age 78 years, 70% female). Approximately 53.2% of patients received an FICB, which was less than a predefined acceptable adherence rate of 75% ( P < 0.001). Approximately 5.0% received an FICB within 4 hours and 17.3% within 6 hours from admission. Admission during daylight hours (7 am -7p m ) when compared with evening hours (7 pm -7 am ) was associated with improved timeliness ([8.3% vs. 0% within 4 hours, P < 0.001] [27.5% vs. 2.4% within 6 hours, P < 0.001]). Improved adherence to the protocol was observed over time (odds ratio: 1.0013, 95% confidence interval, 1.0001-1.0025, P = 0.0388). CONCLUSIONS FICB implementation was poor but gradually improved over time. Few patients received an FICB promptly, especially during night hours. Overall, this study demonstrates that implementation of an FICB program at a Level I academic trauma center can be difficult; however, many hurdles can be overcome with institutional support and dedication of resources such as staff, space, and additional training.
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Affiliation(s)
- Gary Ulrich
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY
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Li L, Li CX, Zhang H, Zhang J. Nerve block reduces the incidence of 3-year postoperative mortality: a retrospective cohort study. Front Surg 2024; 11:1284892. [PMID: 38362458 PMCID: PMC10867203 DOI: 10.3389/fsurg.2024.1284892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose A retrospective cohort study was performed to determine the effect of nerve block on the incidence of postoperative mortality in patients with hip replacement. Methods According to the inclusion and exclusion criteria, patients who were undergoing hip replacement for the first time under general or intraspinal anesthesia, classified as ASA class I-IV, and aged ≥65 years were selected. We collected the general data, past medical history, preoperative laboratory test results, perioperative fluid intake and outflow data, perioperative anesthesia and related drug data, postoperative laboratory results, and correlation time index. Patients with preoperative combined nerve block were included in the N group, and those without combined nerve block were included in the NN group. The patients were followed up via telephone call to assess survival outcomes at 3 years after surgery. Propensity score matching and uni- and multivariate analyses were performed to determine the influence of nerve block and other related factors on postoperative mortality. Results A total of 743 patients were included in this study, including 262 in the N group and 481 in the NN group. Two hundred five patients in both groups remained after propensity score matching. Main result: Preoperative nerve block was associated with reduced mortality three years after surgery. Conclusion Nerve block reduces the incidence of 3-year postoperative mortality, and composite nerve block with general anesthesia and neuraxial anesthesia is worthy of promotion.
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Affiliation(s)
| | | | | | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
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Reider L, Furgiuele D, Wan P, Schaffler B, Konda S. Anesthetic Methods for Hip Fracture. Curr Osteoporos Rep 2024; 22:96-104. [PMID: 38129371 DOI: 10.1007/s11914-023-00835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW To review the benefits, risks, and contraindications of traditional and new anesthesia approaches for hip fracture surgery and describe what is known about the impact of these approaches on postoperative outcomes. RECENT FINDINGS This review describes general and spinal anesthesia, peripheral nerve block techniques used for pain management, and novel, local anesthesia approaches which may provide significant benefit compared with traditional approaches by minimizing high-risk induction time and decreasing respiratory suppression and short- and long-term cognitive effects. Hip fracture surgery places a large physiologic stress on an already frail patient, and anesthesia choice plays an important role in managing risk of perioperative morbidity. New local anesthesia techniques may decrease morbidity and mortality, particularly in higher-risk patients.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Furgiuele
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
| | - Philip Wan
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
| | - Benjamin Schaffler
- Department of Orthopaedic Surgery, NYU Langone Health, New York University Langone Orthopaedic Hospital, 310 East 17Th Street, Suite 1402, New York, NY, 10003, USA
| | - Sanjit Konda
- Department of Orthopaedic Surgery, NYU Langone Health, New York University Langone Orthopaedic Hospital, 310 East 17Th Street, Suite 1402, New York, NY, 10003, USA.
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA.
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Tang L, Li B, Guo S, Zhao X, He B, Liu W, Xia R. Fascia iliaca compartment block can reduce the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement. Front Aging Neurosci 2022; 14:1025545. [PMID: 36545029 PMCID: PMC9762504 DOI: 10.3389/fnagi.2022.1025545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Objective In this study, we aimed to observe the effects of ultrasound-guided fascia iliaca compartment block (FICB) combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement. Methods A total of 84 elderly patients-aged 65-85 years, with American Society of Anesthesiologists physical status III-IV, and scheduled for hip arthroplasty between September 2021 and May 2022-were selected. One or more organs with moderate to severe impairment were included in all patients. The patients were randomly divided into a hypobaric spinal anesthesia group (group C, control group) and an ultrasound-guided FICB combined with hypobaric spinal anesthesia group (group E, experimental group). Group C was given 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia, and group E received ultrasound-guided FICB combined with 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia. The patients were compared using the visual analog scale (VAS) for pain, Harris hip function score, and simple Mini-Mental State Examination (MMSE) scale. Blood β-amyloid (Aβ) and neuronal microtubule-associated protein (tau) levels were measured. We compared intraoperative conditions and post-operative complications between the two groups to assess the effects of FICB combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement. Results At 1 and 3 days after the operation, patients in group C had significantly higher VAS and lower MMES scores than those in group E. The differences were statistically significant at 1 (P < 0.01) and 3 (P < 0.05) days after the operation. At 1 day after operation, the Harris score of patients in group C was significantly lower than that of patients in group E (P < 0.05). The Aβ and tau levels of patients in group C were significantly higher than those of patients in group E at 1 day after the operation (P < 0.01). The Aβ levels of patients in group C were significantly higher than those of patients in group E at 3 days after the operation (P < 0.05). The intraoperative conditions and post-operative complication rates did not differ significantly between the two groups. At 1 day before and 5 days after the operation, there was no difference in any of the indicators. Conclusion By lowering pain and managing Aβ and tau protein concentrations, FICB can successfully lower the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement. Clinical trial registration www.chictr.org.cn, identifier: ChiCTR2100051162.
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Yevsieieva VV, Maslon R, Skobenko YO, Malimonenko MO, Kravchenko DD, Kuprii VO, Shmahoi VL. ASSESSMENT OF THE EFFICIENCY OF ANALGETIC ACTION OF ULTRASOUND-GUIDED FICB AS A COMPONENT OF PERIOPERATIVE MULTIMODAL ANALGESIA IN ERAS- STRUCTURE IN OBESE PATIENTS UNDERGOING TOTAL HIP REPLACEMENT. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2687-2692. [PMID: 36591755 DOI: 10.36740/wlek202211124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To compare the efficiency of analgetic action of Ultrasound-guided FICB and prolonged EA as the components of perioperative multimodal analgesia in ERAS-structure in obese patients undergoing THR. PATIENTS AND METHODS Materials and methods: The retrospective study included 80 patients with obesity, who underwent elective anterolateral THR under conditions of low-flow inhalation anesthesia with sevoflurane in combination with PEA (n1=38) or with FICB (n2=42). Primary endpoints: VAS pain level during the first postoperative day. RESULTS Results: Static and dynamic VAS pain scores were similar in both groups during the first 6 hours. Since the 8th postoperative hour, there was a statistically significant increase in both static and dynamic VAS pain scores in the FICB group. A significant difference in static and dynamic VAS pain scores was obtained with a trend toward an increase in the PEA group within 48 hours (p < 0.05). CONCLUSION Conclusions: USG- FICB is an effective, practically feasible, minimally invasive and safe regional method for eleclive anterior-lateral THR and can be an alternative to PEA in obese patients.
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Affiliation(s)
- Viktoriia V Yevsieieva
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE; STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Radoslaw Maslon
- INDEPENDENT PUBLIC HEALTHCARE COMPLEX, KEDZIERZYN-KOZLE, POLAND
| | - Yevgeniy O Skobenko
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Maksym O Malimonenko
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Daniil D Kravchenko
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Valentyn O Kuprii
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Vasyl L Shmahoi
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
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Gao Y, Li H, Hu H, Xu Y, Zhou J, Liu Y. Effects of Continuous Fascia Iliaca Compartment Block on Early Quality of Recovery After Total Hip Arthroplasty in Elderly Patients: A Randomized Controlled Trial. J Pain Res 2022; 15:1837-1844. [PMID: 35789818 PMCID: PMC9250328 DOI: 10.2147/jpr.s368285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose In recent years, patient-centered postoperative quality of recovery has gained attention. This study aimed to assess the influence of ultrasound-guided continuous fascia iliaca compartment block (CFICB) on early quality of recovery in elderly patients after total hip arthroplasty (THA) using the QoR-15 score. Patients and Methods In this single-center, randomized, prospective study, 60 patients scheduled for unilateral THA were randomized to the CFICB or patient-controlled intravenous analgesia (PCIA) group. The primary outcome was the QoR-15 score. The secondary outcomes were pain score, number of patients requiring rescue analgesics, time of first postoperative ambulation, incidence of postoperative complications, Bromage score, and length of hospital stay. Results The QoR-15 score was significantly higher in the CFICB group than in the PCIA group at 24 h (P < 0.001) after surgery. However, the QoR-15 score was not significantly different at 48 h (P = 0.074) between the two groups. Pain scores at rest and during movement were lower in the CFICB group than in the PCIA group at 12, 24, and 48 h postoperatively (P < 0.05). There was no difference in the number of patients requiring rescue analgesics, time of first postoperative ambulation, incidence of postoperative complications apart from dizziness, or length of hospital stay between the two groups. In addition, Bromage score of 1 point was reported by four patients in the CFICB group at 24 h (P = 0.048) after THA. Conclusion In elderly patients following THA, CFICB improved the quality of recovery at 24 h and reduced pain scores compared with PCIA. The time of first postoperative ambulation and length of hospital stay were not significantly affected.
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Affiliation(s)
- Ying Gao
- Department of Anesthesiology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518110, People's Republic of China
| | - He Li
- Department of Anesthesiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, People's Republic of China
| | - Hongfei Hu
- Department of Anesthesiology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518110, People's Republic of China
| | - Yi Xu
- Department of Anesthesiology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518110, People's Republic of China
| | - Jun Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, People's Republic of China
| | - Youtan Liu
- Department of Anesthesiology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518110, People's Republic of China
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Fei X, Zeng Q, Wang J, Gao Y, Xu F. Bibliometric Analysis of 100 Most-Cited Articles in Delirium. Front Psychiatry 2022; 13:931632. [PMID: 35873259 PMCID: PMC9298977 DOI: 10.3389/fpsyt.2022.931632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 12/19/2022] Open
Abstract
Delirium is a cognitive disorder with complex etiology, which brings a great burden to social health care. Articles with high citation frequency can provide important information about the current research situation in a certain field. Web of Science was used to search the 100 most-cited articles and we extracted key information, such as the authors, countries/regions, institutions, journals, and study types of these articles. CiteSpace was used to visually analyze the keywords. Our bibliometric analysis shows that the attention in this field continues to rise. Authors from the United States published the most articles and Inouye SK is the most influential author in the field. The journals that published these articles have high impact factors. Cohort studies are the main cited articles in this field, and there are a large number of systematic reviews or meta-analyses of cohort studies. Risk factors for delirium, psychometric evaluation, hospital care, and various clinical study design are still the focus of research. In short, we summarized the 100 most-cited articles in the field of delirium to identify the current status and global trends. These results enable researchers to understand the quality and trend of research in the field of delirium and make better use of the classical literature.
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Affiliation(s)
- Xinxing Fei
- Department of Psychiatry Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, China
| | - Qiu Zeng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianxiong Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yaqian Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Fangyuan Xu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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