Gemert van Liesbeth A, Schuurmans Marieke J
VU Medical Centre Amsterdam, De Boellelaan 1117, 1081 HV Amsterdam, The Netherlands.
BMC Nurs. 2007 Mar 29;6:3. doi: 10.1186/1472-6955-6-3.
Delirium is a frequent form of psychopathology in elderly hospitalized patients; it is a symptom of acute somatic illness. The consequences of delirium include high morbidity and mortality, lengthened hospital stay, and nursing home placement. Early recognition of delirium symptoms enables the underlying cause to be diagnosed and treated and can prevent negative outcomes. The aim of this study was to determine which of the two delirium observation screening scales, the NEECHAM Confusion Scale or the Delirium Observation Screening (DOS) scale, has the best discriminative capacity for diagnosing delirium and which is more practical for daily use by nurses.
The project was conducted on four wards of a university hospital; 87 patients were included. During 3 shifts, these patients were observed for symptoms of delirium, which were rated on both scales. A DSM-IV diagnosis of delirium was made or rejected by a geriatrician. Nurses were asked to rate the practical value of both scales using a structured questionnaire.
The sensitivity (0.89-1.00) and specificity (0.86-0.88) of the DOS and the NEECHAM were high for both scales. Nurses rated the practical use of the DOS scale as significantly easier than the NEECHAM.
Successful implementation of standardized observation depends largely on the consent of professionals and their acceptance of a scale. In our hospital, we therefore chose to involve nurses in the choice between two instruments. During the study they were able to experience both scales and give their opinion on ease of use. In the final decision on the instrument we found that both scales were very acceptable in terms of sensitivity and specificity, so the opinion of the nurses was decisive. They were positive about both instruments; however, they rated the DOS scale as significantly easier to use and relevant to their practice. Our findings were obtained from a single site study with a small sample, so a large comparative trial to study the value of both scales further is recommended. On the basis of our experience during this study and findings from the literature with regard to the implementation of delirium guidelines, we will monitor the further implementation of the DOS Scale in our hospital with intensive consultation.
谵妄是老年住院患者常见的精神病理形式，是急性躯体疾病的一种症状。谵妄的后果包括高发病率和死亡率、住院时间延长以及入住疗养院。早期识别谵妄症状有助于诊断和治疗潜在病因，并可预防不良后果。本研究的目的是确定两种谵妄观察筛查量表，即NEECHAM意识错乱量表或谵妄观察筛查（DOS）量表，哪一种对谵妄诊断具有最佳的鉴别能力，以及哪一种在护士日常使用中更实用。
该项目在一所大学医院的四个病房进行，纳入了87名患者。在3个班次期间，观察这些患者的谵妄症状，并使用两种量表进行评分。由一名老年病科医生根据《精神疾病诊断与统计手册》第四版（DSM-IV）做出谵妄诊断或排除诊断。要求护士使用结构化问卷对两种量表的实用价值进行评分。
DOS量表和NEECHAM量表的敏感性（0.89 - 1.00）和特异性（0.86 - 0.88）都很高。护士们认为DOS量表的实际使用比NEECHAM量表明显更容易。
标准化观察的成功实施在很大程度上取决于专业人员的认可及其对量表的接受程度。因此，在我们医院，我们选择让护士参与两种工具的选择。在研究过程中，她们能够体验两种量表并就易用性发表意见。在关于工具的最终决策中，我们发现两种量表在敏感性和特异性方面都非常可接受，因此护士的意见起了决定性作用。她们对两种工具都持肯定态度；然而，她们认为DOS量表使用起来明显更容易且与她们的工作相关。我们的研究结果来自一项单中心小样本研究，因此建议进行大规模比较试验以进一步研究两种量表的价值。基于我们在本研究中的经验以及文献中关于谵妄指南实施的研究结果，我们将通过深入咨询来监测我院DOS量表的进一步实施情况。
