Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit
Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit
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DOI：
10.1007/s10877-016-9873-1
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发表时间：
2017-06-01
影响因子：
2.2
通讯作者：
Swan, Joshua T.
中科院分区：
文献类型：
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作者：
Bui, Lan N.;Pham, Vy P.;Swan, Joshua T.
本研究比较了使用 ICU 混乱评估方法 (CAM-ICU) 检测出谵妄的外科重症监护病房 (ICU) 患者的比例，这些患者收到了使用国际疾病分类第九版临床修改 (ICD-9-CM) 代码的谵妄管理文件，并按谵妄运动亚型分层。这项回顾性队列研究于 2012 年 6 月至 2013 年 5 月在外科 ICU 进行。谵妄每天评估两次，定义为 CAM-ICU 阳性评分≥1。使用相应的里士满激越镇静量表将神志不清的患者分为多动/混合和低动亚型。谵妄的管理文件被定义为具有 >= 32 个唯一 ICD-9-CM 代码中的 1 个。使用皮尔逊卡方检验比较比例。在纳入的患者中，40% (423/1055) 被诊断患有谵妄，17% (183/1055) 的 ICD-9-CM 代码为谵妄。 ICD-9-CM 代码对谵妄的敏感性和特异性分别为 36% 和 95%。 42 % (95 % CI 35-48 %; 105/253) 的多动/混合性谵妄患者和 27 % (95 % CI 20-34 %; 46/170) 低活动性谵妄患者可获得 ICD-9-CM 谵妄编码（相对风险 = 1.5；95 % CI 1.2-2.0；p = 0.002）。 ICD-9-CM 代码对于识别 CAM-ICU 阳性谵妄患者的敏感性较低，并且与活动性谵妄相比，更有可能识别多动/混合性谵妄。
This study compares the proportions of surgical intensive care unit (ICU) patients with delirium detected using the Confusion Assessment Method for the ICU (CAM-ICU) who received administrative documentation for delirium using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, stratified by delirium motoric subtypes. This retrospective cohort study was conducted at a surgical ICU from 06/2012 to 05/2013. Delirium was assessed twice daily and was defined as having >= 1 positive CAM-ICU rating. Delirious patients were categorized into hyperactive/mixed and hypoactive subtypes using corresponding Richmond Agitation Sedation Scales. Administrative documentation of delirium was defined as having >= 1 of 32 unique ICD-9-CM codes. Proportions were compared using Pearson's Chi-square test. Of included patients, 40 % (423/1055) were diagnosed with delirium, and 17 % (183/1055) had an ICD-9-CM code for delirium. The sensitivity and specificity of ICD-9-CM codes for delirium were 36 and 95 %. ICD-9-CM codes for delirium were available for 42 % (95 % CI 35-48 %; 105/253) of patients with hyperactive/mixed delirium and 27 % (95 % CI 20-34 %; 46/170) of patients with hypoactive delirium (relative risk = 1.5; 95 % CI 1.2-2.0; p = 0.002). ICD-9-CM codes yielded a low sensitivity for identifying patients with CAM-ICU positive delirium and were more likely to identify hyperactive/mixed delirium compared with hypoactive delirium.