Delirium screening in an acute geriatric ward by nurses using 4AT: results from a quality improvement project
Delirium screening in an acute geriatric ward by nurses using 4AT: results from a quality improvement project
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DOI：
10.1007/s41999-019-00215-y
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发表时间：
2019-08-01
影响因子：
3.8
通讯作者：
Neerland, Bjorn E.
中科院分区：
文献类型：
--
作者：
Myrstad, Marius;Watne, Leiv O.;Neerland, Bjorn E.
目的：我们旨在描述谵妄的患病率和持续时间，并评估谵妄筛查工具4AT的测试准确性，该工具由急性老年病房的护士执行。发现老年体弱内科患者谵妄患病率为36%，2 / 3患者谵妄在发病后4天内恢复。护士进行4AT的敏感性低于以前由经验丰富的老年病医生或谵妄研究人员进行的研究。在实际临床环境中使用4AT进行谵妄筛查之前，可能需要对工作人员进行全面的培训。【摘要】方法对某急症老年病房质量改进项目进行回顾性分析。入院后24小时内由护士用4AT进行谵妄筛查。根据DSM-5标准对谵妄进行回顾性诊断。结果共纳入59例患者，平均年龄86岁。谵妄的发生率为36%。三分之二的患者在发病后四天内从谵妄中恢复过来。护士进行4AT单点评估的敏感性和特异性分别为50.0%[95%可信区间（CI） 27.2 ~ 72.8]和86.2% （95% CI 68.3 ~ 96.1）。结论急性老年病房患者谵妄患病率较高。护士对谵妄进行4AT的敏感性低于以前由经验丰富的老年病医生或谵妄研究人员进行的研究。
Key summary pointsAimWe aimed to describe the prevalence and duration of delirium, and to evaluate the test accuracy of the delirium screening tool 4AT performed by nurses in an acute geriatric ward.FindingsThe prevalence of delirium in old, frail medical patients was 36%, two out of three patients recovered from their delirium within 4days after onset. The sensitivity of 4AT performed by nurses was lower than in previous studies where 4AT has been undertaken by experienced geriatricians or delirium researchers.MessageA thorough training of the staff might be required before the implementation of delirium screening with 4AT in a real-life clinical setting. AbstractMethodsWe conducted a retrospective chart-based analysis based on a quality improvement project in an acute geriatric ward. Delirium screening with the 4AT was performed by nurses within 24h after hospital admission. Delirium according to DSM-5 criteria was diagnosed retrospectively based on review of patient records.ResultsIn total, 59 patients (mean age 86years) were included. The prevalence of delirium was 36%. Two out of three patients recovered from their delirium within four days after onset. The sensitivity and specificity of the single-point assessment with 4AT performed by nurses were 50.0% [95% confidence interval (CI) 27.2-72.8] and 86.2% (95% CI 68.3-96.1).ConclusionPatients admitted to the acute geriatric ward had a high prevalence of delirium. The sensitivity of the 4AT performed by nurses for delirium was lower than in previous studies where it was undertaken by experienced geriatricians or delirium researchers.