Validation of the Stanford Proxy Test for Delirium (S-PTD) among critical and noncritical patients
Validation of the Stanford Proxy Test for Delirium (S-PTD) among critical and noncritical patients
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DOI：
10.1016/j.jpsychores.2018.08.009
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发表时间：
2018-11-01
影响因子：
4.7
通讯作者：
Maldonado, Jose R.
中科院分区：
文献类型：
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作者：
Alosaimi, Fahad D.;Alghamdi, Ayedh;Maldonado, Jose R.
背景：斯坦福妄想症代理测验(S-PTD)是一种由护士在轮班结束时完成的工具。它的设计是为了使用在护士与病人互动的整个班次中获得的知识。本研究的目的是在重症监护病房(ICU)和非ICU环境下的混合样本中验证S-PTD的有效性。患者由(1)患者的初级护士在轮班结束时使用S-PTD，(2)咨询联络精神科医生根据第五版《精神疾病诊断与统计手册》(DSM-5)进行神经精神病学评估，对患者进行独立盲法评估。采用S-PTD诊断精神分裂症72例(25.0%)，而神经精神病学专家根据DSM-5诊断精神分裂症75例(26.0%)。本研究表明，S-PTD具有很强的区分能力(曲线下面积=0.946，p<；0.001)。以S PTD评分<gt；=3为界值，敏感性为82.7%，特异性为95.3%，阳性预测值为86.1%，阴性预测值为94.0%，总体诊断准确率为92.0%。结论：无论是ICU患者还是普通病房患者，S-PTD都有很好的敏感性和特异性，即使与以需求侧管理为基础的神经精神病学检查的金标准相比，也是如此。
Background: The Stanford Proxy Test for Delirium (S-PTD) is a tool developed to be completed by nurses at the end of their shift. It was designed to use the knowledge acquired during a full shift of nurse-patient interaction. The objective of our study was to validate the S-PTD among a mixed sample of patients in both the intensive care unit (ICU) and non-ICU settings.Methods: A cross-sectional study was conducted in an ICU and three general medical wards in a tertiary care hospital. Patients were independently and blindly assessed for delirium by (1) the patients' primary nurses using the S-PTD at the end of their shift, and (2) a Consultation liaison psychiatrist who conducted a neuropsychiatric evaluation based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).Results: A total 288 patients were included in current analysis. Using the S-PTD, delirium was identified in 72 (25.0%), while an expert neuropsychiatric examination, based on DSM-5 identified delirium in 75 (26.0%) patients. This study demonstrated that the S-PTD has very strong discriminative ability (area under the curve = 0.946, p < 0.001). An S-PTD cut-off score >= 3 was associated with an 82.7% sensitivity, an 95.3% specificity, an 86.1% positive predictive value, a 94.0% negative predictive value, and a 92.0% overall diagnostic accuracy. These results were similar in both ICU and general ward patients.Conclusion: The S-PTD has excellent sensitivity and specificity in detecting delirium in both ICU and ward patients, even when compared with the gold-standard, a DSM-based neuropsychiatric examination.