Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly
Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly
复制标题
DOI：
10.1093/bja/aet167
复制
发表时间：
2013-10-01
影响因子：
9.8
通讯作者：
Needham, D. M.
中科院分区：
文献类型：
--
作者：
Neufeld, K. J.;Leoutsakos, J. S.;Needham, D. M.
背景。老年人术后谵妄是常见的，与不良预后相关，但往往未被发现。缺乏在术后环境中验证的谵妄筛查工具。本研究比较了两种筛查工具[重症监护病房混淆评估法（CAM-ICU）和护理谵妄症状检查表（NuDESC）]与基于dsm - iv的谵妄诊断，在术后设置神经精神病学检查。连续招募英语患者，>= 70岁，接受全身麻醉手术并能够提供知情同意。在麻醉后护理病房（PACU）和住院期间的日常检查中，比较了每种筛查工具与神经精神检查的诊断测试特征，并对重复测量进行了调整。在PACU评估的91名患者中，神经精神病学检查发现了45%的谵妄，在随后的58名住院患者的166名谵妄评估中，这一比例为32%。在PACU和所有重复评估中，CAM-ICU谵妄检测的敏感性[95%置信区间（CI）]分别为28%（16-45%）和28% (17-42%)；对于NuDESC（评分阈值>= 2），分别为32%（19-48%）和29%(19-42%)；对于NuDESC（评分阈值>= 1），分别为80%（65-91%）和72%（60-82%）。CAM-ICU和NuDESC的特异性均为> - 90%（阈值>= 2）；在PACU中，NuDESC（阈值>= 1）的特异性在所有评估中分别为69%（54-80%）和80%（73-85%）。虽然具有高度特异性，但CAM-ICU和NuDESC（阈值>= 2）对术后谵妄的识别都不够敏感；NuDESC（阈值>= 1）增加了敏感性，但降低了特异性。
Background. Postoperative delirium in the elderly is common and associated with poor outcomes, but often goes unrecognized. Delirium screening tools, validated in postoperative settings are lacking. This study compares two screening tools [Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Nursing Delirium Symptom Checklist (NuDESC)] with a DSM-IV-based diagnosis of delirium, conducted by neuropsychiatric examination in postoperative settings.Methods. Consecutive English-speaking patients, >= 70 yr, undergoing surgery with general anaesthesia and capable of providing informed consent, were recruited. Diagnostic test characteristics were compared for each screening tool vs neuropsychiatric examination, both in the Post-Anaesthesia Care Unit (PACU), and daily during inpatient hospitalization, adjusting for repeated measures.Results. Neuropsychiatric examination identified delirium in 45% of 91 patients evaluated in the PACU and in 32% of 166 subsequent delirium assessments on the ward in the 58 admitted patients. The sensitivity [95% confidence interval (CI)] of delirium detection of the CAM-ICU in the PACU, and in all repeated assessments was 28% (16-45%) and 28% (17-42%), respectively; for the NuDESC (scoring threshold >= 2), 32% (19-48%) and 29% (19-42%), respectively, and the NuDESC (threshold >= 1), 80% (65-91%) and 72% (60-82%), respectively. Specificity was >90% for both the CAM-ICU and the NuDESC (threshold >= 2); specificity for the NuDESC (threshold >= 1), in the PACU was 69% (54-80%) and 80% (73-85%) for all assessments.Conclusions. While highly specific, neither CAM-ICU nor NuDESC (threshold >= 2) are adequately sensitive to identify delirium post-operatively; NuDESC (threshold >= 1) increases sensitivity, but reduces specificity.