A tale of two methods: chart and interview methods for identifying delirium.
A tale of two methods: chart and interview methods for identifying delirium.
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DOI：
10.1111/jgs.12684
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发表时间：
2014-03
影响因子：
6.3
通讯作者：
Inouye SK
中科院分区：
文献类型：
--
作者：
Saczynski JS;Kosar CM;Xu G;Puelle MR;Schmitt E;Jones RN;Marcantonio ER;Wong B;Isaza I;Inouye SK
访谈和图表为基础的方法来识别谵妄已经得到验证。然而，每种方法的相对优势和局限性都没有得到描述，也没有系统地研究一种综合方法（使用访谈和图表）。比较图表和访谈为基础的方法来识别谵妄。参与者为300例年龄在70岁以上的患者，他们接受了重大择期手术（大多数是骨科手术），在住院期间每天使用意识模糊评估方法（CAM;基于访谈的方法）进行访谈，并使用经验证的图表审查方法（基于图表的方法）审查其病历中的谵妄。我们检查了两种方法的一致率和使用每种方法确定的患者特征。比较临床结局（住院时间、术后并发症、出院处置）的预测有效性。在没有金标准的情况下，预测值无法计算。通过基于访谈的方法，谵妄的累积发生率为23%（n= 68），通过基于图表的方法为12%（n=35），通过联合方法为27%（n=82）。总体一致性为80%; kappa为0.30。不同的方法在检测的心理特征和发病时间。基于图表的方法错过了在缺乏精神激动或不适当行为特征的CAM识别患者中的谵妄。基于CAM的方法错过了夜班期间发生的图表识别病例。该组合方法对所有临床结局具有较高的预测有效性。访谈和图表为基础的方法有特定的优势，确定谵妄。联合方法可捕获数量最多、范围最广的谵妄病例。
Interview and chart-based methods for identifying delirium have been validated. However, relative strengths and limitations of each method have not been described, nor has a combined approach (using both interviews and chart), been systematically examined. To compare chart and interview-based methods for identification of delirium. Participants were 300 patients aged 70+ undergoing major elective surgery (majority were orthopedic surgery) interviewed daily during hospitalization for delirium using the Confusion Assessment Method (CAM; interview-based method) and whose medical charts were reviewed for delirium using a validated chart-review method (chart-based method). We examined rate of agreement on the two methods and patient characteristics of those identified using each approach. Predictive validity for clinical outcomes (length of stay, postoperative complications, discharge disposition) was compared. In the absence of a gold-standard, predictive value could not be calculated. The cumulative incidence of delirium was 23% (n= 68) by the interview-based method, 12% (n=35) by the chart-based method and 27% (n=82) by the combined approach. Overall agreement was 80%; kappa was 0.30. The methods differed in detection of psychomotor features and time of onset. The chart-based method missed delirium in CAM-identified patients laacking features of psychomotor agitation or inappropriate behavior. The CAM-based method missed chart-identified cases occurring during the night shift. The combined method had high predictive validity for all clinical outcomes. Interview and chart-based methods have specific strengths for identification of delirium. A combined approach captures the largest number and the broadest range of delirium cases.
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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：
4.7
作者：
Breitbart, W;Rosenfeld, B;Passik, S
通讯作者：
Passik, S
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：
120.7
作者：
MARCANTONIO, ER;GOLDMAN, L;LEE, TH
通讯作者：
LEE, TH