Vinson David R
Department of Emergency Medicine, The Permanente Medical Group, Roseville, California, USA.
J Emerg Med. 2006 Aug;31(2):139-45. doi: 10.1016/j.jemermed.2006.05.006.
Akathisia is a common side-effect of dopamine receptor D2 antagonists that often remains undiagnosed. Conventional diagnostic and grading instruments are cumbersome and can be difficult to remember and to use. To facilitate the Emergency Department (ED) assessment of acute drug-induced akathisia, I sought to derive and evaluate a simplified instrument using the database compiled from three prior studies of acute drug-induced akathisia. These studies had used a conventional Long instrument in the prospective assessment of 360 adult ED patients aged 17-65 years who received intravenous prochlorperazine (10 mg) in the treatment of headache or nausea and vomiting. The Short instrument was derived from the Long instrument using the Wilcoxon z-test to identify the individual findings most strongly associated with the diagnosis of akathisia. I then retrospectively applied the Short instrument to the cohort and used pairwise analyses to compare results obtained from both instruments. Sensitivity, specificity and receiver operating characteristic curves were used to analyze the impact of instrument form on diagnostic accuracy. The Long criteria diagnosed akathisia in 118 (32.8%; 95% confidence interval [CI] 28.0%-37.9%) patients and the Short diagnosed akathisia in 120 (33.3%; 95% CI 28.5%-38.5%). When akathisia was characterized categorically as either absent or present, the Short criteria agreed with the Long in 358 cases (99.4%; 95% CI 98.0%-99.9%). Treating the diagnoses established by the Long criteria as the gold standard, the Short instrument had a sensitivity of 100.0% (95% CI 96.9%-100%) and a specificity of 99.2% (95% CI 97.0%-99.9%). Regarding the accuracy of categorizing akathisia into four severity grades, the Short scale agreed in 325 of 360 cases (90.3%; 95% CI 86.7%-93.1%) and misgraded 35 cases (9.7%; 95% CI 6.9%-13.3%), 34 of which fell within one grade of the Long scale. The Short instrument is highly accurate in diagnosing acute drug-induced akathisia, in comparison with the Long criteria, in the ED setting. The Short instrument also provides fairly accurate grading of akathisia severity. This simplified instrument should facilitate the detection and treatment of akathisia in the ED.
静坐不能是多巴胺受体D2拮抗剂常见的副作用，常未被诊断出来。传统的诊断和分级工具使用繁琐，且难以记忆和应用。为便于急诊科（ED）对急性药物性静坐不能进行评估，我试图利用此前三项关于急性药物性静坐不能研究的数据库，得出并评估一种简化工具。这些研究在前瞻性评估360例年龄在17至65岁的成年ED患者时使用了传统的长版工具，这些患者接受静脉注射氯丙嗪（10毫克）治疗头痛或恶心呕吐。短版工具是通过威尔科克森z检验从长版工具中推导得出的，以确定与静坐不能诊断最密切相关的个体发现。然后我将短版工具回顾性应用于该队列，并进行成对分析以比较两种工具得出的结果。使用敏感性、特异性和受试者工作特征曲线来分析工具形式对诊断准确性的影响。长版标准诊断出118例（32.8%；95%置信区间[CI]28.0%-37.9%）患者患有静坐不能，短版诊断出120例（33.3%；95%CI 28.5%-38.5%）。当将静坐不能明确分为存在或不存在时，短版标准在358例（99.4%；95%CI 98.0%-99.9%）中与长版标准一致。将长版标准确立的诊断作为金标准，短版工具的敏感性为100.0%（95%CI 96.9%-100%），特异性为99.2%（95%CI 97.0%-99.9%）。关于将静坐不能分为四个严重程度等级的准确性，短版量表在360例中的325例（90.3%；95%CI 86.7%-93.1%）中与长版量表一致，35例（9.7%；95%CI 6.9%-13.3%）分级错误，其中34例与长版量表的分级相差一个等级。与长版标准相比，在急诊科环境中，短版工具在诊断急性药物性静坐不能方面具有高度准确性。短版工具还能对静坐不能的严重程度进行相当准确的分级。这种简化工具应有助于急诊科对静坐不能的检测和治疗。
