Nurses' recognition of delirium and its symptoms - Comparison of nurse and researcher ratings
Nurses' recognition of delirium and its symptoms - Comparison of nurse and researcher ratings
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DOI：
10.1001/archinte.161.20.2467
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发表时间：
2001-11-12
影响因子：
--
通讯作者：
Cooney, LM
中科院分区：
文献类型：
--
作者：
Inouye, SK;Foreman, MD;Cooney, LM
背景：护士在认识精神错乱中起着关键作用，然而精神错乱往往不被护士认识。我们的目标是比较护士基于常规临床观察的混乱评估方法和基于认知测试的研究人员对精神错乱的评分，并确定与护士认知不足相关的因素。方法：在一项前瞻性研究中，797名70岁及以上的患者接受了2721名护士和研究人员配对的精神错乱评分。结果：2721例观察者中有239例(9%)或797例患者中有131例(16%)出现妄想症，与研究者相比，护士仅在19%的观察者和31%的患者中发现了妄想症。护士对精神错乱及其主要特征评分的敏感度普遍较低(15%-31%)，但特异度较高(91%-99%)。护士和研究人员之间几乎所有的分歧都是因为护士对精神错乱的认识不足。护士认知不足的4个独立危险因素分别是：低动症(调整优势比(OR)，7.4；95%可信区间[CI]，4.2-12.9)，80岁以上(OR，2.8；95%CI，1.7-4.7)，视力障碍(OR，2.2；95%CI，1.2-4.0)，痴呆症(OR，2.1；95%CI，1.2-3.7)。护士认知不足的风险随着风险因素的数量从2%(0个风险因素)增加到6%(1个风险因素)、15%(2个风险因素)和44%(3或4个风险因素；P趋势
Background: Nurses play a key role in recognition of delirium, yet delirium is often unrecognized by nurses. Our goals were to compare nurse ratings for delirium using the Confusion Assessment Method based on routine clinical observations with researcher ratings based on cognitive testing and to identify factors associated with underrecognition by nurses.Methods: In a prospective study, 797 patients 70 years and older underwent 2721 paired delirium ratings by nurses and researchers. Patient-related factors associated with underrecognition of delirium by nurses were examined.Results: Delirium occurred in 239 (9%) of 2721 observations or 131 (16%) of 797 patients, Nurses identified delirium in only 19% of observations and 31% of patients compared with researchers. Sensitivities of nurses' ratings for delirium and its key features were generally low (15%-31%); however, specificities were high (91%-99%). Nearly all disagreements between nurse and researcher ratings were because of underrecognition of delirium by the nurses. Four independent risk factors for underrecognition by nurses were identified: hypoactive delirium (adjusted odds ratio [OR], 7.4; 95% confidence interval [CI], 4.2-12.9), age 80 years and older (OR, 2.8; 95% CI, 1.7-4.7), vision impairment (OR, 2.2; 95% CI, 1.2-4.0), and dementia (OR, 2.1; 95% CI, 1.2-3.7). The risk for underrecognition by nurses increased with the number of risk factors present from 2% (0 risk factors) to 6% (1 risk factor), 15% (2 risk factors), and 44% (3 or 4 risk factors; P-trend