Delirium in mechanically ventilated patients - Validity and reliability of the Confusion Assessment Method for the intensive care unit (CAM-ICU)
Delirium in mechanically ventilated patients - Validity and reliability of the Confusion Assessment Method for the intensive care unit (CAM-ICU)
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DOI：
10.1001/jama.286.21.2703
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发表时间：
2001-12-05
影响因子：
120.7
通讯作者：
Dittus, R
中科院分区：
文献类型：
--
作者：
Ely, EW;Inouye, SK;Dittus, R
谵妄是重症监护病房（ICU）的常见问题。准确的诊断受到与机械通气患者沟通困难和缺乏有效的谵妄仪器用于ICU的限制。目的验证谵妄评估仪器，该仪器使用标准化的非语言评估机械通气患者，并确定谵妄在此类患者中的发生率。设计和设置前瞻性队列研究测试ICU患者的混乱评估方法（CAM-1）。研究对象从2000年2月1日至2000年7月15日，共招募了111名连续机械通气患者，其中96人（86.5%）可评价谵妄的发生，主要指标谵妄的发生率及诊断的敏感性、特异性、和评价者之间的可靠性谵妄评估使用CAM-ICU，每天由2名重症监护研究护士，与评估谵妄专家使用精神疾病诊断和统计手册，第四版，criteria.Results共完成471每日配对评估。与诊断谵妄的参考标准相比，使用CAM-ICU的2名研究护士的敏感性为100%和93%，特异性为98%和100%，评价者间可靠性较高（kappa =0.96; 95%置信区间，0.92-0.99）。亚组比较中的评价者间可靠性指标显示，65岁或以上的患者的kappa值为0.92，疑似痴呆症患者的kappa值为0.99，急性生理学和慢性健康评估II评分等于或高于中位数23的患者的kappa值为0.94（所有P
Context Delirium is a common problem in the intensive care unit (ICU). Accurate diagnosis is limited by the difficulty of communicating with mechanically ventilated patients and by lack of a validated delirium instrument for use in the ICU.Objectives To validate a delirium assessment instrument that uses standardized nonverbal assessments for mechanically ventilated patients and to determine the occurrence rate of delirium in such patients.Design and Setting Prospective cohort study testing the Confusion Assessment Method for ICU Patients (CAM-ICU) in the adult medical and coronary ICUs of a US university-based medical center.Participants A total of 111 consecutive patients who were mechanically ventilated were enrolled from February 1, 2000, to July 15, 2000, of whom 96 (86.5%) were evaluable for the development of delirium and 15 (13.5%) were excluded because they remained comatose throughout the investigation.Main Outcome Measures Occurrence rate of delirium and sensitivity, specificity, and interrater reliability of delirium assessments using the CAM-ICU, made daily by 2 critical care study nurses, compared with assessments by delirium experts using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.Results A total of 471 daily paired evaluations were completed. Compared with the reference standard for diagnosing delirium, 2 study nurses using the CAM-ICU had sensitivities of 100% and 93%, specificities of 98% and 100%, and high interrater reliability (kappa =0.96; 95% confidence interval, 0.92-0.99). Interrater reliability measures across subgroup comparisons showed kappa values of 0.92 for those aged 65 years or older, 0.99 for those with suspected dementia, or 0.94 for those with Acute Physiology and Chronic Health Evaluation II scores at or above the median value of 23 (all P