A chart-based method for identification of delirium: Validation compared with interviewer ratings using the confusion assessment method
A chart-based method for identification of delirium: Validation compared with interviewer ratings using the confusion assessment method
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DOI：
10.1111/j.1532-5415.2005.53120.x
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发表时间：
2005-02-01
影响因子：
6.3
通讯作者：
Agostini, JV
中科院分区：
文献类型：
--
作者：
Inouye, SK;Leo-Summers, L;Agostini, JV
目的：验证一种基于图表的精神分裂症诊断方法，并将其与使用混淆评估法(CAM)的面试者直接评估进行比较。设计：前瞻性验证研究。设置：教学医院。对象：919名老年住院患者。测量：建立一种基于图表的精神分裂症识别工具，并与参考标准面试者评分进行比较，后者使用直接认知评估完成对精神错乱的CAM。训练有素的护士图表抽象员对所有访谈数据都是盲目的，包括认知和CAM评分。结果：根据CAM，115例(12.5%)患者存在妄想症。基于图表的工具的敏感性为74%，特异性为83%，阳性结果的似然比为4.4。图表和采访者评分的总体一致性为82%，kappa=0.41。相比之下，根据国际疾病分类、第9次修订、临床修订、行政法规，对精神错乱的敏感性为3%，特异性为99%。与不正确辨认精神错乱相关的独立因素是痴呆症、严重疾病和高基线精神错乱风险。有了所有这三个因素，图表工具错误识别患者的可能性是没有这些因素的三倍。结论：一种基于图表的妄想症工具得到了验证，它应该对老年人的患者安全和质量改进计划有用。由于潜在的分类错误，不建议将基于图表的仪器用于个别患者护理或诊断目的。
OBJECTIVES: To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM).DESIGN: Prospective validation study.SETTING: Teaching hospital.PARTICIPANTS: Nine hundred nineteen older hospitalized patients.MEASUREMENTS: A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined.RESULTS: Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present.CONCLUSION: A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes.