Preliminary development of an ultrabrief two-item bedside test for delirium
Preliminary development of an ultrabrief two-item bedside test for delirium
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DOI：
10.1002/jhm.2418
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Fick, Donna M.;Inouye, Sharon K.;Marcantonio, Edward R.
谵妄是常见的，病态的，和昂贵的，但在住院的老年人中被大大低估。病历审查，并与家庭成员和护士面谈，以确定是否存在精神疾病诊断和统计手册，第4版定义的谵妄。参与者还接受了三维混乱评估方法（3D-CAM），这是一种简短且经过验证的谵妄评估方法。对3D-CAM的单个项目和成对项目进行评估，以确定相对于参考标准谵妄诊断的灵敏度和特异性。在201名参与者中（平均年龄84岁，62%为女性），42名（21%）根据临床参考标准患有谵妄。具有最佳测试特征的单个项目是一年中的月份，灵敏度为83%（95%置信区间[CI]：69%-93%），特异性为69%（95% CI：61%-76%）。最好的两项屏幕是一年中的几个月和星期几的组合？灵敏度为93%（95%CI：81%-99%），特异性为64%（95%CI：56%-70%）。结论我们确定了谵妄敏感性>80%的单个项目和>90%的成对项目。如果前瞻性验证，这些项目将作为一个初始的创新筛选步骤，谵妄识别住院老年人。医院医学杂志2015;10：645-650。(c)2015年医院医学学会
BACKGROUNDDelirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults.OBJECTIVETo identify the best single and pair of mental status test items that predict the presence of delirium.DESIGN, SETTINGDiagnostic test evaluation study that enrolled medicine inpatients aged 75 years or older at an academic medical center.METHODSPatients underwent a clinical reference standard assessment involving a patient interview, medical record review, and interviews with family members and nurses to determine the presence or absence of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition defined delirium. Participants also underwent the three-dimensional Confusion Assessment Method (3D-CAM), a brief, validated assessment for delirium. Individual items and pairs of items from the 3D-CAM were evaluated to determine sensitivity and specificity relative to the reference standard delirium diagnosis.RESULTSOf the 201 participants (mean age 84 years, 62% female), 42 (21%) had delirium based on the clinical reference standard. The single item with the best test characteristics was months of the year backwards with a sensitivity of 83% (95% confidence interval [CI]: 69%-93%) and specificity of 69% (95% CI: 61%-76%). The best 2-item screen was the combination of months of the year backwards and what is the day of the week? with a sensitivity of 93% (95% CI: 81%-99%) and specificity of 64% (95% CI: 56%-70%).CONCLUSIONSWe identified a single item with >80% and pair of items with >90% sensitivity for delirium. If validated prospectively, these items will serve as an initial innovative screening step for delirium identification in hospitalized older adults. Journal of Hospital Medicine 2015;10:645-650. (c) 2015 Society of Hospital Medicine