Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients.
Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients.
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DOI：
10.1001/jamanetworkopen.2021.37267
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发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Avidan MS
中科院分区：
文献类型：
--
作者：
Oberhaus J;Wang W;Mickle AM;Becker J;Tedeschi C;Maybrier HR;Upadhyayula RT;Muench MR;Lin N;Schmitt EM;Inouye SK;Avidan MS
对于接受过手术的老年患者，3分钟诊断性神志不清评估方法能否提供与标准神志不清评估方法类似的谵妄检测？在299例60岁及以上手术患者的队列研究中，3分钟诊断混淆评估法与较长的混淆评估法表现出良好的一致性。这些结果表明，3分钟诊断混乱评估方法可能是一个有用的工具，临床谵妄检测的患者进行了手术。本队列研究评估了3分钟诊断混淆评估法（3D-CAM）检测老年患者术后谵妄的性能。谵妄是老年患者术后常见的并发症，通常未被发现，并可能导致更糟糕的结果。3分钟诊断混乱评估法（3D-CAM）可作为谵妄临床常规诊断的实用工具。比较用于研究目的的长形CAM与3D-CAM检测术后谵妄的效果。这项队列研究是在美国一家三级医院进行的，研究对象是2015年至2018年间参加正在进行的临床试验的老年患者。纳入的参与者年龄在60岁或以上，正在接受需要至少2天住院的主要选择性外科手术。数据分析时间为2019年2月至4月。手术时间至少2小时，需要全身麻醉并计划拔管。同时使用3D-CAM评估和长格式CAM评估患者谵妄，评分基于标准化的认知评估。使用重复测量的Cohen κ、广义线性混合效应模型和Bland-Altman分析来检验这两种方法之间的一致性。16位评分员共进行471次CAM和3D-CAM访谈，包括299例患者（平均[SD]年龄69[6.5]岁），其中大多数为男性（152例[50.8%]），白人（263例[88.0%]），非心脏手术（211例[70.6%]）。两种仪器均具有良好的类内相关性（CAM为0.84,3D-CAM为0.98）。Cohen κ在CAM和3D-CAM之间表现出良好的总体一致性（κ = 0.71; 95% CI， 0.58至0.83）。根据混合效应模型，3D-CAM与CAM之间的差异有统计学意义（固定效应估计差异为- 0.68；95% CI为- 1.32 ~ - 0.05;P = 0.04）。Bland-Altman分析显示，3D-CAM诊断谵妄的概率是CAM诊断谵妄的概率的两倍多（概率比，2.78;95% CI， 2.44至3.23）。3D-CAM仪器与长形式CAM一致，可能为检测术后谵妄提供实用和敏感的临床工具，但3D-CAM可能会过度诊断谵妄。
Can the 3-Minute Diagnostic Confusion Assessment Method provide similar delirium detection as the standard Confusion Assessment Method for older patients who have undergone surgery? In this cohort study of 299 patients aged 60 years or older who had undergone surgery, the 3-Minute Diagnostic Confusion Assessment Method showed good agreement with the longer Confusion Assessment Method. These results suggest the 3-Minute Diagnostic Confusion Assessment Method might be a useful tool for clinical delirium detection in patients who have undergone surgery. This cohort study evaluates the performance of the 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) for detecting postoperative delirium in older patients. Delirium is a common postoperative complication in older patients that often goes undetected and might lead to worse outcomes. The 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) might be a practical tool for routine clinical diagnosis of delirium. To assess the 3D-CAM for detecting postoperative delirium compared with the long-form CAM used for research purposes. This cohort study of older patients enrolled in ongoing clinical trials between 2015 and 2018 was conducted at a single tertiary US hospital. Included participants were aged 60 years or older undergoing major elective surgical procedures that required at least a 2-day hospital stay. Data were analyzed between February and April 2019. Surgical procedures of at least 2 hours in length requiring general anesthesia with planned extubation. Patients were concurrently assessed for delirium using the 3D-CAM assessment and the long-form CAM, scored based on a standardized cognitive assessment. Agreement between these 2 methods was tested using Cohen κ with repeated measures, a generalized linear mixed-effects model, and Bland-Altman analysis. Sixteen raters conducted 471 concurrent CAM and 3D-CAM interviews including 299 patients (mean [SD] age, 69 [6.5] years), the majority of whom were men (152 [50.8%]), were White (263 [88.0%]), and had noncardiac operations (211 [70.6%]). Both instruments had good intraclass correlation (0.84 for the CAM and 0.98 for the 3D-CAM). Cohen κ demonstrated good overall agreement between the CAM and 3D-CAM (κ = 0.71; 95% CI, 0.58 to 0.83). According to the mixed-effects model, there was statistically significant disagreement between the 3D-CAM and CAM (estimated difference in fixed effect, −0.68; 95% CI, −1.32 to −0.05; P = .04). Bland-Altman analysis showed the probability of a delirium diagnosis with the 3D-CAM was more than twice the probability of a delirium diagnosis with the CAM (probability ratio, 2.78; 95% CI, 2.44 to 3.23). The 3D-CAM instrument demonstrated agreement with the long-form CAM and might provide a pragmatic and sensitive clinical tool for detecting postoperative delirium, with the caveat that the 3D-CAM might overdiagnose delirium.
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影响因子：
2.9
作者：
Wildes TS;Winter AC;Maybrier HR;Mickle AM;Lenze EJ;Stark S;Lin N;Inouye SK;Schmitt EM;McKinnon SL;Muench MR;Murphy MR;Upadhyayula RT;Fritz BA;Escallier KE;Apakama GP;Emmert DA;Graetz TJ;Stevens TW;Palanca BJ;Hueneke R;Melby S;Torres B;Leung JM;Jacobsohn E;Avidan MS
通讯作者：
Avidan MS
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
影响因子：
5.7
作者：
Inouye, SK;Rushing, JT;Pompei, P
通讯作者：
Pompei, P
影响因子：
5.7
作者：
Mickle, Angela M.;Maybrier, Hannah R.;Wildes, Troy S.
通讯作者：
Wildes, Troy S.
影响因子：
5.7
作者：
Kuczmarska, Aleksandra;Ngo, Long H.;Marcantonio, Edward R.
通讯作者：
Marcantonio, Edward R.