Validation of a consensus method for identifying delirium from hospital records.
Validation of a consensus method for identifying delirium from hospital records.
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DOI：
10.1371/journal.pone.0111823
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Davis D
中科院分区：
文献类型：
--
作者：
Kuhn E;Du X;McGrath K;Coveney S;O'Regan N;Richardson S;Teodorczuk A;Allan L;Wilson D;Inouye SK;MacLullich AM;Meagher D;Brayne C;Timmons S;Davis D
谵妄越来越被认为是认知能力下降的一个重要决定因素。因此，对现有的测量认知结果的队列研究的分析可以受益于确定回顾性谵妄诊断的方法。本研究的目的是开发和验证这样一种方法谵妄检测使用常规病历在英国和爱尔兰。谵妄的时点患病率研究提供了谵妄诊断的参考标准评级。在对研究结果设盲的情况下，以标准化的方式从参与者的医疗记录中汇编临床小插曲，描述在病例确定之前的整个病例记录中记录的任何相关谵妄症状。一个专家小组将每个小插曲评定为不太可能、可能或可能的谵妄，并通过协商一致解决分歧。从95例病例记录中，由5名经过培训的临床医生提取了424个小插曲。根据参考标准，有29例谵妄病例。受试者的中位年龄为76.6岁（四分位数间距为54.6 - 82.5）。与最初的研究DSM-IV诊断相比，图表提取方法给出的阳性似然比（LR）为7.8（95% CI 5.7-12.0），负LR为0.45（95% CI 0.40-0.47）（灵敏度0.58（95% CI 0.53-0.62）;特异性0.93（95% CI 0.90-0.95）; AUC 0.86（95% CI 0.82-0.89））。该方法诊断为可能的谵妄，阳性LR 3.5（95% CI 2.9-4.3）和阴性LR 0.15（95% CI 0.11-0.21）（灵敏度0.89（95% CI 0.85-0.91）;特异性0.75（95% CI 0.71-0.79）; AUC 0.86（95% CI 0.80-0.89））。这种图表提取方法可以回顾性地诊断住院患者的谵妄，具有良好的准确性。这有可能在常规医疗记录可用的队列研究中回顾性识别谵妄。住院和流行病学数据之间的记录联系的这个例子可能会导致进一步了解急性疾病之间的相互关系，作为一种暴露，一系列慢性健康结果。
Delirium is increasingly considered to be an important determinant of trajectories of cognitive decline. Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using routine medical records in UK and Ireland. A point prevalence study of delirium provided the reference-standard ratings for delirium diagnosis. Blinded to study results, clinical vignettes were compiled from participants' medical records in a standardised manner, describing any relevant delirium symptoms recorded in the whole case record for the period leading up to case-ascertainment. An expert panel rated each vignette as unlikely, possible, or probable delirium and disagreements were resolved by consensus. From 95 case records, 424 vignettes were abstracted by 5 trained clinicians. There were 29 delirium cases according to the reference standard. Median age of subjects was 76.6 years (interquartile range 54.6 to 82.5). Against the original study DSM-IV diagnosis, the chart abstraction method gave a positive likelihood ratio (LR) of 7.8 (95% CI 5.7–12.0) and the negative LR of 0.45 (95% CI 0.40–0.47) for probable delirium (sensitivity 0.58 (95% CI 0.53–0.62); specificity 0.93 (95% CI 0.90–0.95); AUC 0.86 (95% CI 0.82–0.89)). The method diagnosed possible delirium with positive LR 3.5 (95% CI 2.9–4.3) and negative LR 0.15 (95% CI 0.11–0.21) (sensitivity 0.89 (95% CI 0.85–0.91); specificity 0.75 (95% CI 0.71–0.79); AUC 0.86 (95% CI 0.80–0.89)). This chart abstraction method can retrospectively diagnose delirium in hospitalised patients with good accuracy. This has potential for retrospectively identifying delirium in cohort studies where routine medical records are available. This example of record linkage between hospitalisations and epidemiological data may lead to further insights into the inter-relationship between acute illness, as an exposure, for a range of chronic health outcomes.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
影响因子：
6.7
作者：
Maclullich AM;Anand A;Davis DH;Jackson T;Barugh AJ;Hall RJ;Ferguson KJ;Meagher DJ;Cunningham C
通讯作者：
Cunningham C
DOI：
10.1111/j.1532-5415.2005.53120.x
发表时间：
2005-02-01
影响因子：
6.3
作者：
Inouye, SK;Leo-Summers, L;Agostini, JV
通讯作者：
Agostini, JV
影响因子：
6.9
作者：
JORM, AF
通讯作者：
JORM, AF
影响因子：
--
作者：
Bossuyt, PM;Reitsma, JB;de Vet, HCE
通讯作者：
de Vet, HCE