Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients.
Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients.
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DOI：
10.1016/j.psym.2017.05.005
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发表时间：
2017-11
期刊：
影响因子：
3.4
通讯作者：
Douglas V
中科院分区：
文献类型：
--
作者：
Hargrave A;Bastiaens J;Bourgeois JA;Neuhaus J;Josephson SA;Chinn J;Lee M;Leung J;Douglas V
指南建议每天对住院患者进行谵妄监测。可用的谵妄筛查工具尚未被验证用于不同的住院患者之间的护士。我们试图验证护理谵妄筛查量表（Nu-DESC）在这些情况下。2015年8月至2016年2月进行了一项设盲横断面和质量改善研究。护士的Nu-DESC评分与精神障碍诊断和统计手册-5（DSM-5）标准的谵妄诊断进行比较。共纳入405例连续住院患者。Nu-DESC阳性（阈值评分≥2）患者与相同数量的Nu-DESC阴性患者按性别、年龄和护理单位进行匹配。护士在每12小时轮班记录每位患者的Nu-DESC评分。Nu-DESC设盲评价者连续2天对患者进行访谈。谵妄诊断由医生使用DSM-5标准应用于收集的研究数据。计算Nu-DESC的灵敏度和特异性。在一项探索性分析中，分析了Nu-DESC的性能，并增加了床旁注意力指标。Nu-DESC在阈值≥2时的灵敏度为42%（95% CI：33-53%）。特异性为98%（97- 98%）。阈值≥1时，灵敏度为67%（52- 80%），特异性为93%（90-95%）。类似的结果被发现与注意力任务。Nu-DESC是一种特异性谵妄检测工具，但在通常建议的临界点≥2时不敏感。使用≥1的阈值或增加注意力测试可增加灵敏度，但特异性略有降低。
Guidelines recommend daily delirium monitoring of hospitalized patients. Available delirium-screening tools have not been validated for use by nurses among diverse inpatients. We sought to validate the Nursing Delirium-Screening Scale (Nu-DESC) under these circumstances. A blinded cross-sectional and quality-improvement study was conducted from August 2015–February 2016. Nurses’ Nu-DESC scores were compared to delirium diagnosis according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria. A total of 405 consecutive hospitalized patients were included. Nu-DESC-positive (threshold score ≥2) patients were matched with equal numbers of Nu-DESC-negative patients, by sex, age, and nursing unit. Nurses recorded a Nu-DESC score for each patient on every 12-hour shift. A Nu-DESC-blinded evaluator interviewed patients for 2 consecutive days. Delirium diagnosis was determined by physicians using DSM-5 criteria applied to collected research data. Sensitivity and specificity of the Nu-DESC were calculated. In an exploratory analysis, the performance of the Nu-DESC was analyzed with the addition of bedside measures of attention. The sensitivity of the Nu-DESC at a threshold of ≥2 was 42% (95% CI: 33–53%). Specificity was 98% (97– 98%). At a threshold of ≥1, sensitivity was 67% (52– 80%) and specificity 93% (90–95%). Similar results were found with the addition of attention tasks. The Nu-DESC is a specific delirium detection tool, but it is not sensitive at the usually proposed cut point of ≥2. Using a threshold of ≥1 or adding a test of attention increase sensitivity with a minor decrease in specificity.
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影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
影响因子：
4
作者：
de Rooij, Sophia E.;van Munster, Barbara C.;Levi, Marcel
通讯作者：
Levi, Marcel
影响因子：
5.7
作者：
Inouye, SK;Rushing, JT;Pompei, P
通讯作者：
Pompei, P
影响因子：
2.6
作者：
Douglas, Vanja C.;Hessler, Christine S.;Josephson, S. Andrew
通讯作者：
Josephson, S. Andrew
影响因子：
3.7
作者：
Kuhn E;Du X;McGrath K;Coveney S;O'Regan N;Richardson S;Teodorczuk A;Allan L;Wilson D;Inouye SK;MacLullich AM;Meagher D;Brayne C;Timmons S;Davis D
通讯作者：
Davis D