Lemiengre Joke, Nelis Tine, Joosten Etienne, Braes Tom, Foreman Marquis, Gastmans Chris, Milisen Koen
Center for Biomedical Ethics and Law, Cahtolic University of Leuven, Leuven, Belgium.
J Am Geriatr Soc. 2006 Apr;54(4):685-9. doi: 10.1111/j.1532-5415.2006.00667.x.
A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5-month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses. Delirium was identified in 36 of the 258 patients (14%) or in 42 of the 641 paired observations (6.5%). The SENS method of the CAM algorithm as administered by bedside nurses had the greatest diagnostic accuracy, with 66.7% sensitivity and 90.7% specificity; the SPEC method had 23.8% sensitivity and 97.7% specificity. Bedside nurses had difficulties recognizing the features of acute onset, fluctuation, and altered level of consciousness. For both scoring methods, bedside nurses had difficulties with the identification of elderly patients with delirium but succeeded in diagnosing correctly those patients without delirium in more than 90% of observations. Given these results, additional education about delirium with special attention to guided training of bedside nurses in the use of an assessment strategy such as the CAM for the recognition of delirium symptoms is warranted.
一项前瞻性描述性研究旨在评估护士在日常实践中床边应用的谵妄评估方法（CAM）的诊断效度。将CAM的两种不同评分方法（特异性（SPEC）方法和敏感性（SENS）方法）与标准参照（由经过培训的研究护士完成的CAM）进行比较。在5个月的时间里，所有连续入住比利时鲁汶大学医院急性老年病房的患者均纳入该研究。纳入研究的258名老年住院患者接受了床边护士和经过培训的研究护士对谵妄进行的641次配对但独立的评定。258名患者中有36名（14%）被诊断为谵妄，或641次配对观察中有42次（6.5%）被诊断为谵妄。床边护士应用的CAM算法的SENS方法具有最高的诊断准确性，敏感性为66.7%，特异性为90.7%；SPEC方法的敏感性为23.8%，特异性为97.7%。床边护士在识别急性起病、波动及意识水平改变的特征方面存在困难。对于两种评分方法，床边护士在识别谵妄老年患者方面存在困难，但在超过90%的观察中成功正确诊断了无谵妄的患者。鉴于这些结果，有必要开展关于谵妄的额外教育，尤其要注重对床边护士进行有针对性的培训，使其掌握如CAM等评估策略以识别谵妄症状。
