Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU
Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU
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DOI：
10.1007/s11606-015-3514-0
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发表时间：
2016-03-01
影响因子：
5.7
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Kuczmarska, Aleksandra;Ngo, Long H.;Marcantonio, Edward R.
背景：谵妄在老年住院患者中很常见，并且与不良结局相关，但大多数病例未被发现。在重症监护病房外进行系统性谵妄识别的最佳方法仍然是未知的。目的：在普通内科住院患者中进行ICU混淆评估方法（CAM-ICU）和新开发的使用混淆评估方法（3D-CAM）的谵妄3分钟诊断评估的比较有效性研究。设计：横断面比较有效性研究。两个非重症监护的一般医学单位在一个单一的学术medical center.Participants：住院的一般医学患者年龄>= 75 years.MEASUREMENTS：临床医生进行了一个参考标准评估谵妄，包括病人的采访，家庭访谈，并审查的医疗记录。专家小组使用DSM-IV标准确定是否存在谵妄。两名盲法研究助理以随机顺序管理CAM-ICU和3D-CAM，我们确定了他们的诊断测试特征，并与参考标准进行了比较。结果：在101名参与者中（平均年龄84 +/- 5.5岁，61%为女性，25%患有痴呆症），19%根据参考标准被归类为谵妄。3D-CAM和CAM-ICU的评价时间相似。3D-CAM检测谵妄的灵敏度[95%置信区间（CI）]为95%[74%，100%]，CAM-ICU为53%[29%，76%]，而两种仪器的特异性均> 90%。亚组分析表明，CAM-ICU的敏感性为30%，在轻度谵妄患者与100%的3D-CAM。结论：在这项比较有效性研究中，我们发现，3D-CAM有显着更高的敏感性比CAM-ICU住院老年普通内科患者，和相似的管理时间。因此，3D-CAM可能是该患者人群中谵妄的一种上级筛查工具。
BACKGROUND: Delirium is common in older hospitalized patients and is associated with poor outcomes, yet most cases go undetected. The best approach for systematic delirium identification outside the intensive care unit remains unknown.OBJECTIVE: To conduct a comparative effectiveness study of the Confusion Assessment Method for the ICU (CAM-ICU) and the newly developed 3-minute diagnostic assessment for delirium using the Confusion Assessment Method (3D-CAM) in general medicine inpatients.DESIGN: Cross-sectional comparative effectiveness study.SETTING: Two non-intensive care general medicine units at a single academic medical center.PARTICIPANTS: Hospitalized general medicine patients aged >= 75 years.MEASUREMENTS: Clinicians performed a reference standard assessment for delirium that included patient interviews, family interviews, and review of the medical record. An expert panel determined the presence or absence of delirium using DSM-IV criteria. Two blinded research assistants administered the CAM-ICU and the 3D-CAM in random order, and we determined their diagnostic test characteristics compared to the reference standard.RESULTS: Among the 101 participants (mean age 84 +/- 5.5 years, 61 % women, 25 % with dementia), 19 % were classified as delirious based on the reference standard. Evaluation times for the 3D-CAM and CAM-ICU were similar. The sensitivity [95 % confidence interval (CI)] of delirium detection for the 3D-CAM was 95 % [74 %, 100 %] and for the CAM-ICU was 53%[29%, 76 %], while specificity was >90 % for both instruments. Subgroup analyses showed that the CAM-ICU had sensitivity of 30 % in patients with mild delirium vs. 100 % for the 3D-CAM.CONCLUSIONS: In this comparative effectiveness study, we found that the 3D-CAM had substantially higher sensitivity than the CAM-ICU in hospitalized older general medicine patients, and similar administration time. Therefore, the 3D-CAM may be a superior screening tool for delirium in this patient population.