Functional status after critical illness: agreement between patient and proxy assessments
Functional status after critical illness: agreement between patient and proxy assessments
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DOI：
10.1093/ageing/afu163
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发表时间：
2015-05-01
期刊：
影响因子：
6.7
通讯作者：
Pisani, Margaret A.
中科院分区：
文献类型：
--
作者：
Ahasic, Amy M.;Van Ness, Peter H.;Pisani, Margaret A.
背景：老年患者入住重症监护病房（ICU）期间和之后的基线功能状态评估常常受到与危重疾病相关的挑战的阻碍，例如认知功能障碍、神经心理发病率和疼痛。为了探索精心选择的代理评估的可靠性，我们设计了有区别的代理选择，并通过评估 ICU 出院后 1 个月的日常生活活动 (ADL) 来评估患者和代理反应之间的一致性。方法：入住内科 ICU 的 60 岁以上患者被纳入研究谵妄的前瞻性家长队列。代理人在入住 ICU 时经过仔细筛选，以选择最佳的可用受访者。后续访谈（包括 ADL 工具）在 ICU 出院后 1 个月进行。我们检查了 179 名患者与代理人配对的后续访谈。 Kappa 统计评估了观察者间的一致性，McNemar 的精确检验评估了反应差异。结果：患者平均年龄 73.3 +/- 8.1 岁，其中 29% 有认知障碍的证据。代理人最常见的是配偶（38%）或子女（39%）。总体而言，除了一项基本 ADL 和一项工具性 ADL 之外，患者和代理人之间在评估除一项基本 ADL 和一项工具性 ADL 之外的所有评估方面均存在显着 (x >= 0.6) 至极好的一致性 (x >= 0.8)。 结论：在 ICU 出院后 1 个月评估当前功能状态时，在 ICU 入院时精心挑选的代理人与老年患者的观察者间一致性较高。这激发了对替代评估的进一步研究，这些评估可以在危重疾病的早期使用，以评估病前的功能状态。
Background: assessment of baseline functional status of older patients during and after intensive care unit (ICU) admission is often hampered by challenges related to the critical illness such as cognitive dysfunction, neuropsychological morbidity and pain. To explore the reliability of assessments by carefully chosen proxies, we designed a discriminating selection of proxies and evaluated agreement between patient and proxy responses by assessing activities of daily living (ADLs) at 1 month post-ICU discharge.Methods: patients >= 60 years old admitted to the medical ICU were enrolled in a prospective parent cohort studying delirium. Proxies were carefully screened at ICU admission to choose the best available respondent. Follow-up interviews, including instruments for ADLs, were conducted 1 month after ICU discharge. We examined 179 paired patient-proxy follow-up interviews. Kappa statistics assessed inter-observer agreement, and McNemar's exact test assessed response differences.Results: patients averaged 73.3 +/- 8.1 years old with 29% having evidence of cognitive impairment. Proxies were most commonly spouses (38%) or children (39%). Overall, there was substantial (x >= 0.6) to excellent agreement (x >= 0.8) between patients and proxies on assessment of all but one basic and one instrumental ADL.Conclusion: proxies carefully chosen at ICU admission show high levels of inter-observer agreement with older patients when assessing current functional status at 1 month post-ICU discharge. This motivates further study of proxy assessments that could be used earlier in critical illness to assess premorbid functional status.