Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study
Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study
复制标题
DOI：
10.3389/fneur.2019.01198
复制
发表时间：
2019-11-12
影响因子：
3.4
通讯作者：
Mengel, Annerose
中科院分区：
文献类型：
--
作者：
Bosselmann, Christian;Zurloh, Jan;Mengel, Annerose
背景：10 - 30%的脑卒中患者出现脑卒中后谵妄。这导致住院时间延长，死亡率上升。因此，需要早期发现和治疗。所有已建立的谵妄筛查工具都需要一定程度的语言功能。我们试图调查重症监护谵妄筛查清单（ICDSC）是否适用于卒中后失语症患者的谵妄筛查。方法：对2017年7月至2018年12月连续入住图宾根大学医院卒中病房的成年患者进行前瞻性队列研究。将指标测试ICDSC与DSM-V诊断标准作为参考标准进行比较。获得了诊断精度和一致性的度量。结果：共纳入346例患者。231例（66.8%）患者出现失语，115例（33.2%）患者无失语。231例失语症患者中有83例（36%）出现谵妄，115例非失语症患者中有32例（27.8%）出现谵妄（p = 0.132）。对于非失语患者，在>= 4点的临界值下，敏感性为100%，特异性为78%。对于失语症患者，该测试表现较差，灵敏度和特异性分别为98%和55%。有必要将临界值增加到>= 5点。通过该方法，灵敏度为90% (95% CI, 81.9-95.8%)，特异性为75% （95% CI, 67.2-81.8%）。与DSM-V标准的一致程度是“实质性的”（Cohen的kappa = 0.61）。结论：提高ICDSC截止值至>= 5分，可有效筛查失语患者谵妄。需要进一步的研究来确定中风后谵妄的特征。
Background: Ten to thirty percent of stroke patients suffer from post-stroke delirium. This leads to a longer hospital stay and increased mortality. Therefore, early detection and treatment are needed. All established delirium screening tools require some degree of language function. We sought to investigate whether the Intensive Care Delirium Screening Checklist (ICDSC) is suitable for delirium screening in patients with post-stroke aphasia. Methods: A prospective cohort study was carried out in adult patients consecutively admitted to the Stroke Unit of University Hospital Tuebingen, between July 2017 and December 2018. The index test, ICDSC, was compared with the DSM-V diagnostic criteria as reference standard. Measures of diagnostic precision and the degree of agreement were obtained. Results: Three hundred and forty six patients were included in the analysis. Aphasia was present in 231 (66.8%) and absent in 115 (33.2%) patients. Delirium was present in 83 out of 231 (36%) patients with aphasia and 32 out of 115 (27.8%) patients without aphasia (p = 0.132). For patients without aphasia, sensitivity and specificity at the established cut-off value of >= 4 points were 100% and 78%, respectively. For patients with aphasia, the test demonstrated inferior performance, with a sensitivity and specificity of 98% and 55%, respectively. It was necessary to increase the cut-off value to >= 5 points. Through this, sensitivity was 90% (95% CI, 81.9-95.8%) and specificity was 75% (95% CI, 67.2-81.8%). The degree of agreement to the DSM-V criteria was "substantial" (Cohen's kappa = 0.61). Conclusion: For the purpose of delirium screening in patients with aphasia, increasing the ICDSC cut-off value to >= 5 points enables effective screening. Further studies are necessary to characterize post-stroke delirium.