The 2014 updated version of the Confusion Assessment Method for the Intensive Care Unit compared to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders and other current methods used by intensivists.
The 2014 updated version of the Confusion Assessment Method for the Intensive Care Unit compared to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders and other current methods used by intensivists.
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DOI：
10.1186/s13613-018-0377-7
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发表时间：
2018-03-01
影响因子：
8.1
通讯作者：
Jaber S
中科院分区：
文献类型：
--
作者：
Chanques G;Ely EW;Garnier O;Perrigault F;Eloi A;Carr J;Rowan CM;Prades A;de Jong A;Moritz-Gasser S;Molinari N;Jaber S
三分之一的重症监护室（ICU）患者会出现谵妄。然而，如果不使用谵妄筛查工具，如重症监护谵妄筛查量表（ICDSC）或ICU混乱评估方法（CAM-ICU），床边临床医生对谵妄的认识不足。CAM-ICU于2014年进行了更新，以改善全球临床医生的使用。与新的参考标准《精神疾病诊断与统计手册》第5版（DSM-5）相比，它从未得到过验证。我们在一家法国学术医院的16床内科-外科ICU中进行了一项前瞻性心理测量研究，以测量2014年更新的CAM-ICU与DSM-5作为参考标准的诊断性能。我们纳入了里士满躁动镇静量表（RASS）≥ −3的连续成人患者，无既存认知障碍、精神病或脑损伤。由神经心理学专家使用DSM-5的操作方法，由研究者使用CAM-ICU和ICDSC，由床边临床医生和ICU患者独立评估谵妄。考虑到神经心理学家DSM-5评估作为参考标准（主要终点），计算灵敏度、特异性、阳性和阴性预测值。使用κ系数总结CAM-ICU观察者间一致性，以及谵妄诊断方法与参考标准之间的一致性，随后使用Z检验进行比较。在纳入分析的108名患者中，38%的患者被专家诊断为谵妄。CAM-ICU诊断的敏感性为83%，特异性为100%，阳性预测值为100%，阴性预测值为91%。与参考标准相比，CAM-ICU具有显著的（p < 0.05）一致性较高（κ = 0.86 ± 0.05）高于医生、住院医师和护士的诊断（κ = 0.65 ± 0.09; 0.63 ± 0.09; 0.61 ± 0.09），以及患者自己感觉谵妄的印象（κ = 0.02 ± 0.11）。ICDSC（κ = 0.69 ± 0.07）和CAM-ICU之间的差异不显著（p = 0.054）。CAM-ICU显示了观察者间一致性的高可靠性（κ = 0.87 ± 0.06）。根据DSM-5标准，2014年更新版本的CAM-ICU是有效的，并且在研究环境中观察者之间的一致性是可靠的。谵妄仍然没有得到床边临床医生的认可。本文的在线版本（10.1186/s13613-018-0377-7）包含补充材料，可供授权用户使用。
One third of patients admitted to an intensive care unit (ICU) will develop delirium. However, delirium is under-recognized by bedside clinicians without the use of delirium screening tools, such as the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU). The CAM-ICU was updated in 2014 to improve its use by clinicians throughout the world. It has never been validated compared to the new reference standard, the Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5). We made a prospective psychometric study in a 16-bed medical–surgical ICU of a French academic hospital, to measure the diagnostic performance of the 2014 updated CAM-ICU compared to the DSM-5 as the reference standard. We included consecutive adult patients with a Richmond Agitation Sedation Scale (RASS) ≥ −3, without preexisting cognitive disorders, psychosis or cerebral injury. Delirium was independently assessed by neuropsychological experts using an operationalized approach to DSM-5, by investigators using the CAM-ICU and the ICDSC, by bedside clinicians and by ICU patients. The sensitivity, specificity, positive and negative predictive values were calculated considering neuropsychologist DSM-5 assessments as the reference standard (primary endpoint). CAM-ICU inter-observer agreement, as well as that between delirium diagnosis methods and the reference standard, was summarized using κ coefficients, which were subsequently compared using the Z-test. Delirium was diagnosed by experts in 38% of the 108 patients included for analysis. The CAM-ICU had a sensitivity of 83%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 91%. Compared to the reference standard, the CAM-ICU had a significantly (p < 0.05) higher agreement (κ = 0.86 ± 0.05) than the physicians,’ residents’ and nurses’ diagnoses (κ = 0.65 ± 0.09; 0.63 ± 0.09; 0.61 ± 0.09, respectively), as well as the patient’s own impression of feeling delirious (κ = 0.02 ± 0.11). Differences between the ICDSC (κ = 0.69 ± 0.07) and CAM-ICU were not significant (p = 0.054). The CAM-ICU demonstrated a high reliability for inter-observer agreement (κ = 0.87 ± 0.06). The 2014 updated version of the CAM-ICU is valid according to DSM-5 criteria and reliable regarding inter-observer agreement in a research setting. Delirium remains under-recognized by bedside clinicians. The online version of this article (10.1186/s13613-018-0377-7) contains supplementary material, which is available to authorized users.
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影响因子：
8.8
作者：
Chanques, G;Jaber, S;Eledjam, JJ
通讯作者：
Eledjam, JJ
影响因子：
8.1
作者：
Delaney LJ;Van Haren F;Lopez V
通讯作者：
Lopez V
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
9.8
作者：
Chanques, G.;Tarri, T.;Jaber, S.
通讯作者：
Jaber, S.
影响因子：
8.8
作者：
Balas MC;Vasilevskis EE;Olsen KM;Schmid KK;Shostrom V;Cohen MZ;Peitz G;Gannon DE;Sisson J;Sullivan J;Stothert JC;Lazure J;Nuss SL;Jawa RS;Freihaut F;Ely EW;Burke WJ
通讯作者：
Burke WJ