Simon Samuel E, Bergmann Margaret A, Jones Richard N, Murphy Katherine M, Orav E John, Marcantonio Edward R
Mathematica Policy Research, Cambridge, MA, USA.
J Am Med Dir Assoc. 2006 Sep;7(7):412-5. doi: 10.1016/j.jamda.2006.02.006. Epub 2006 May 30.
To evaluate the interrater reliability of a structured delirium assessment method for nonclinician interviewers in elderly patients newly admitted for postacute care.
Prospective assessment using dyads of nonclinician raters.
Postacute (Medicare) units at 6 skilled nursing facilities.
Forty elderly patients newly admitted for postacute care from medical or surgical units at acute care hospitals.
Subjects underwent dual delirium assessments within 5 days of admission. The standardized delirium assessment included the Mini-Mental Status Exam and Digit Span to assess overall cognitive function, the Delirium Symptom Interview to elicit specific delirium symptoms, the Memorial Delirium Assessment Scale to measure the severity of delirium, and the Confusion Assessment Method (CAM) to make the diagnosis of delirium. A coding protocol that linked observations to specific coding was used to improve reliability.
The structured delirium assessment process produced very high interobserver agreement for all instruments. Kappa for agreement on delirium diagnosis was 0.95.
Nonclinician interviewers using a structured delirium assessment achieved reliability that rivaled or exceeded that of trained clinical assessors in other studies. Nonclinicians may offer an effective alternative for the assessment of delirium among postacute patients in skilled nursing facilities.
评估一种结构化谵妄评估方法在非临床访谈者对新入住接受急性后期护理的老年患者进行评估时的评分者间信度。
采用非临床评分者二元组进行前瞻性评估。
6家熟练护理机构的急性后期（医疗保险）病房。
40名从急性护理医院内科或外科病房新入住接受急性后期护理的老年患者。
受试者在入院5天内接受两次谵妄评估。标准化谵妄评估包括简易精神状态检查表和数字广度测试以评估整体认知功能、谵妄症状访谈以引出特定谵妄症状、纪念谵妄评估量表以测量谵妄严重程度以及谵妄评定方法（CAM）以诊断谵妄。使用一种将观察结果与特定编码相联系的编码方案来提高信度。
结构化谵妄评估过程在所有工具上都产生了非常高的观察者间一致性。谵妄诊断一致性的kappa值为0.95。
使用结构化谵妄评估的非临床访谈者所达到的信度可与其他研究中训练有素的临床评估者相媲美或更高。非临床人员可为熟练护理机构中急性后期患者的谵妄评估提供一种有效的替代方案。
