Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
复制标题
危重症患者谵妄的评估：重症监护病房意识模糊评估法（CAM - ICU）的验证
DOI：
10.1097/00003246-200107000-00012
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发表时间：
2001-07-01
影响因子：
8.8
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
Ely, EW;Margolin, R;Inouye, SK
目的：为了开发和验证一种仪器，用于重症监护病房，以准确诊断谵妄的危重病人谁往往是非语言，因为mechanicalventilation.Design：前瞻性队列研究。设置：成人医疗和冠状动脉重症监护病房的三级保健，大学为基础的医疗中心。患者：38例患者入住重症监护室。测量和主要结果：我们设计和测试了一个修改后的版本的混乱评估方法用于重症监护室的患者，并称之为CAM-ICU。由两名研究护士和一名使用CAM-ICU的重症监护医师从重症监护病房入院到出院的每日评分与参考标准进行比较，参考标准是使用精神疾病诊断和统计手册（第四版）中的谵妄标准的谵妄专家。共完成了293次每日配对评估，所有观察结果中，42%的参考标准诊断为谵妄，27%为昏迷。为了仅纳入交互式患者评价并避免多日研究患者的重复观察者偏倚，我们仅对每例患者进行了首次警戒或昏睡的common-common-assessment评价。38例患者中有33例（87%）在重症监护室住院期间发生谵妄，平均持续时间为4.2 ± 1.7天。排除因缺乏特征性谵妄特征而对昏迷患者进行的评估，两位重症监护研究护士和重症监护医师的CAM-ICU评分显示出较高的评分者间可靠性，kappa统计值分别为0.84、0.79和0.95（p <0.001）。两名护士和重症监护医生的敏感性时，使用CAM-ICU与参考标准相比，分别为95%，96%和100%，而他们的特异性分别为93%，93%和89%，respectives.Conclusions：CAM-ICU表现出良好的信度和效度时，护士和医生使用，以确定谵妄在重症监护病房的病人。CAM-ICU可能是一个有用的工具，用于临床和研究目的，以监测谵妄在这个具有挑战性的患者群体。
Objective: To develop and validate an instrument for use in the intensive care unit to accurately diagnose delirium in critically ill patients who are often nonverbal because of mechanical ventilation.Design: Prospective cohort study.Setting: The adult medical and coronary intensive care units of a tertiary care, university-based medical center. Patients: Thirty-eight patients admitted to the intensive care units.Measurements and Main Results: We designed and tested a modified version of the Confusion Assessment Method for use in intensive care unit patients and called it the CAM-ICU. Daily ratings from intensive care unit admission to hospital discharge by two study nurses and an intensivist who used the CAM-ICU were compared against the reference standard, a delirium expert who used delirium criteria from the Diagnostic and Statistical Manual of Mental Disorders (fourth edition). A total of 293 daily, paired evaluations were completed, with reference standard diagnoses of delirium in 42% and coma in 27% of all observations. To include only interactive patient evaluations and avoid repeat-observer bias for patients studied on multiple days, we used only the first-alert or lethargic com parison evaluation in each patient. Thirty-three of 38 patients (87%) developed delirium during their intensive care unit stay, mean duration of 4.2 +/- 1.7 days. Excluding evaluations of comatose patients because of lack of characteristic delirium features, the two critical care study nurses and intensivist demonstrated high interrater reliability for their CAM-ICU ratings with kappa statistics of 0.84, 0.79, and 0.95, respectively (p < .001). The two nurses' and intensivist's sensitivities when using the CAM-ICU compared with the reference standard were 95%, 96%, and 100%, respectively, whereas their specificities were 93%, 93%, and 89%, respectively.Conclusions: The CAM-ICU demonstrated excellent reliability and validity when used by nurses and physicians to identify delirium in intensive care unit patients. The CAM-ICU may be a useful instrument for both clinical and research purposes to monitor delirium in this challenging patient population.