Adaptation and Validation of a Chart-Based Delirium Detection Tool for the ICU (CHART-DEL-ICU).
Adaptation and Validation of a Chart-Based Delirium Detection Tool for the ICU (CHART-DEL-ICU).
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ICU(CHART-DEL-ICU)基于图表的妄想症检测工具的改编和验证。
DOI：
10.1111/jgs.16987
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发表时间：
2021-04
影响因子：
6.3
通讯作者：
Fiest KM
中科院分区：
文献类型：
--
作者：
Krewulak KD;Hiploylee C;Ely EW;Stelfox HT;Inouye SK;Fiest KM
调整并验证用于重症成人的基于图表的谵妄检测工具。验证研究。一家学术医院的内科-外科重症监护室（ICU）。基于图表的谵妄检测工具（CHART‐DEL）适用于重症成人（CHART ‐DEL‐ICU），并与前瞻性谵妄评估（即，由神经精神病学家培训的研究护士进行的临床评估（参考标准）和常规谵妄筛查工具（意识模糊评估方法（CAM‐ICU））和（重症监护谵妄筛查量表（ICDSC））。对原始CHART‐DEL工具进行了调整，以包括医生报告的ICDSC评分（针对可能的谵妄）和里士满-躁动镇静量表评分（针对意识水平改变和躁动）。两名经过培训的病历摘要员对所有谵妄评估设盲，手动从病历和电子病历中提取谵妄相关信息，并评定是否存在谵妄（四级：不确定、可能、很可能、明确）或不存在（无证据）。手动提取了213例患者的谵妄相关信息图表，这些患者被纳入一项前瞻性队列研究（包括前瞻性谵妄评估）。CHART‐DEL‐ICU工具具有极佳的评定者间可靠性（kappa = 0.90）。与参考标准相比，灵敏度为66.0%（95% CI = 59.3-72.3%），特异性为82.1%（95% CI = 78.0-85.7%），临界点包括明确、很可能、可能和不确定的谵妄。与添加CAM-ICU和ICDSC相比，单独使用CHART-DEL-ICU的AUC为74.1%（95% CI = 70.4-77.8%）（CAM-ICU/CHART-DEL-ICU：80.9%（95% CI = 77.8-83.9%），P = 0.01; ICDSC/CHART-DEL-ICU：79.2%（95% CI = 75.9-82.6%），P = 0.03）。与单独使用基于图表的方法相比，基于图表的谵妄检测工具与常规谵妄筛查工具（CAM‐ICU和ICDSC）结合使用时，可以提高诊断准确性。这为从病历中回顾性检测谵妄提供了一种可能性，用于研究或增加常规谵妄筛查方法以发现遗漏的谵妄病例。
To adapt and validate a chart‐based delirium detection tool for use in critically ill adults. Validation study. Medical‐surgical intensive care unit (ICU) in an academic hospital. A chart‐based delirium detection tool (CHART‐DEL) was adapted for use in critically ill adults (CHART‐DEL‐ICU) and compared with prospective delirium assessments (i.e., clinical assessments (reference standard) by a research nurse trained by a neuropsychiatrist and routine delirium screening tools Confusion Assessment Method (CAM‐ICU)) and (Intensive Care Delirium Screening Checklist (ICDSC)). The original CHART‐DEL tool was adapted to include physician‐reported ICDSC score (for probable delirium) and Richmond‐Agitation Sedation Scale score (for altered level of consciousness and agitation). Two trained chart abstractors blinded to all delirium assessments manually abstracted delirium‐related information from medical charts and electronic medical records and rated if delirium was present (four levels: uncertain, possible, probable, definite) or absent (no evidence). Charts were manually abstracted for delirium‐related information for 213 patients who were included in a prospective cohort study that included prospective delirium assessments. The CHART‐DEL‐ICU tool had excellent interrater reliability (kappa = 0.90). Compared to the reference standard, the sensitivity was 66.0% (95% CI = 59.3–72.3%) and specificity was 82.1% (95% CI = 78.0–85.7%), with a cut‐point that included definite, probable, possible, and uncertain delirium. The AUC of the CHART‐DEL‐ICU alone is 74.1% (95% CI = 70.4–77.8%) compared with the addition of the CAM‐ICU and ICDSC (CAM‐ICU/CHART‐DEL‐ICU: 80.9% (95% CI = 77.8–83.9%), P = .01; ICDSC/CHART‐DEL‐ICU: 79.2% (95% CI = 75.9–82.6%), P = .03). A chart‐based delirium detection tool has improved diagnostic accuracy when combined with routine delirium screening tools (CAM‐ICU and ICDSC), compared to a chart‐based method on its own. This presents a potential for retrospective detection of delirium from medical charts for research or to augment routine delirium screening methods to find missed cases of delirium.
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影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
6.3
作者：
Saczynski JS;Kosar CM;Xu G;Puelle MR;Schmitt E;Jones RN;Marcantonio ER;Wong B;Isaza I;Inouye SK
通讯作者：
Inouye SK
影响因子：
8.8
作者：
Devlin, John W.;Skrobik, Yoanna;Alhazzani, Waleed
通讯作者：
Alhazzani, Waleed
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：
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