CLARIFYING CONFUSION - THE CONFUSION ASSESSMENT METHOD - A NEW METHOD FOR DETECTION OF DELIRIUM
CLARIFYING CONFUSION - THE CONFUSION ASSESSMENT METHOD - A NEW METHOD FOR DETECTION OF DELIRIUM
复制标题
DOI：
10.7326/0003-4819-113-12-941
复制
发表时间：
1990-12-15
影响因子：
39.2
通讯作者：
HORWITZ, RI
中科院分区：
文献类型：
--
作者：
INOUYE, SK;VANDYCK, CH;HORWITZ, RI
开发和验证一种新的标准化混乱评估方法（CAM），使非精神科临床医生能够在高危环境中快速检测谵妄。前瞻性验证研究。在耶鲁大学（研究中心1）的普通内科病房和门诊老年评估中心以及芝加哥大学（研究中心2）的普通内科病房进行。该研究包括56名受试者，年龄范围为65至98岁。在研究中心1，10例有谵妄和20例无谵妄的患者参与;在研究中心2，16例有谵妄和10例无谵妄的患者参与。一个专家小组通过建立共识的过程制定了CAM。CAM工具可以在不到5分钟的时间内完成，包括来自精神障碍诊断和统计手册（DSM-III-R）的9个可操作标准。一个先验的假设，建立了四个标准的诊断价值：急性发作和波动的过程中，注意力不集中，思维混乱，意识水平的改变。诊断谵妄的CAM算法需要同时存在第一和第二标准以及第三或第四标准。在这两个地点，CAM做出的诊断与精神科医生做出的诊断同时得到验证。在站点1和站点2，灵敏度值分别为100%和94%;特异性值分别为95%和90%;阳性预测准确度值分别为91%和94%;阴性预测准确度值分别为100%和90%。CAM算法对于谵妄九个特征的所有可能组合具有最高的预测准确性。CAM被证明有收敛协议与其他四个精神状态测试，包括简易精神状态检查。CAM的观察者间信度较高（kappa = 0.81-1.0）。
To develop and validate a new standardized confusion assessment method (CAM) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk settings. Prospective validation study. Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University (site 1) and in general medicine wards, at the University of Chicage (site 2). The study included 56 subjects, ranging in age from 65 to 98 years. At site 1, 10 patients with and 20 without delirium particpated; at site, 2, 16 patients with and 10 without delirium participated. An expert panel developed the CAM through a consensus building process. The CAM instrument, which can be completed in less than 5 minutes, consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). An a priori hypothesis was established for the diagnostic value of four criteria: acute onset and fluctuating course, inattention, disorganized thinking, and altered levels of consciousness. The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion. At both sites, the diagnoses made by the CAM were concurrently validated against the diagnoses made by psychiatrists. At sites 1 and 2 values for sensitivity were 100% and 94%, respectively; values for specificity were 95% and 90%; values for positive predictive accuracy were 91% and 94%; and values for negative predictive accuracy were 100% and 90%. The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium. The CAM was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination. The interobserver reliability of the CAM was high (kappa = 0.81-1.0).