Devlin John W, Fong Jeffrey J, Schumaker Greg, O'Connor Heidi, Ruthazer Robin, Garpestad Erik
Northeastern University School of Pharmacy, Northeastern University, Boston, MA, USA.
Crit Care Med. 2007 Dec;35(12):2721-4; quiz 2725. doi: 10.1097/01.ccm.0000292011.93074.82.
Although medical intensive care unit nurses at our institution routinely use the Intensive Care Delirium Screening Checklist (ICDSC) to identify delirium, physicians rely on traditional diagnostic methods. We sought to measure the effect of physicians' use of the ICDSC on their ability to detect delirium.
Before-after study.
Medical intensive care unit of an academic medical center.
A total of 25 physicians with >or=1 month of clinical experience in the medical intensive care unit conducted 300 delirium assessments in 100 medical intensive care unit patients.
Physicians sequentially evaluated two patients for delirium using whatever diagnostic method preferred. Following standardized education regarding ICDSC use, each physician evaluated two different patients for delirium using the ICDSC. Each physician assessment was preceded by consecutive, but independent, evaluations for delirium by the patient's nurse and then a validated judge using the ICDSC. Before (PRE) physician ICDSC use, the validated judge identified delirium in five patients; the physicians and nurses identified delirium in zero and four of these patients, respectively. The physicians incorrectly identified delirium in four additional patients. After (POST) physician ICDSC use, the validated judge identified delirium in 11 patients; the physicians and nurses identified delirium in eight and ten of these patients, respectively. The physicians incorrectly identified delirium in one patient. After physician ICDSC use, agreement improved between both the physicians and validated judge (PRE kappa = -0.14 [95% confidence interval {CI} = -0.27 to -0.02] to POST kappa = 0.67 [95% CI = 0.38 to 0.96]) and physicians and nurses (PRE kappa = -0.15 [95% CI = -0.29 to -0.02] to POST kappa = 0.58 [95% CI = 0.25 to 0.91]). Nurses vs. validated judge agreement was strong in both periods (PRE kappa = 0.65 [95% CI = 0.29 to 1.00] and POST kappa = 0.92 [95% CI = 0.76 to 1.00]).
Use of the ICDSC, along with education supporting its use, improves the ability of physicians to detect delirium in the medical intensive care unit.
尽管我们机构的医学重症监护病房护士常规使用重症监护谵妄筛查清单（ICDSC）来识别谵妄，但医生仍依赖传统诊断方法。我们试图评估医生使用ICDSC对其检测谵妄能力的影响。
前后对照研究。
一所学术性医学中心的医学重症监护病房。
共有25名在医学重症监护病房有≥1个月临床经验的医生对100名医学重症监护病房患者进行了300次谵妄评估。
医生先用其偏好的任何诊断方法依次评估两名患者的谵妄情况。在接受关于ICDSC使用的标准化培训后，每位医生使用ICDSC评估另外两名不同患者的谵妄情况。在每次医生评估之前，患者的护士会连续但独立地使用ICDSC对谵妄进行评估，然后由一位经验证的评判者进行评估。在医生使用ICDSC之前（PRE），经验证的评判者识别出5例谵妄患者；医生和护士分别识别出其中0例和4例谵妄患者。医生还错误地将另外4例患者识别为谵妄。在医生使用ICDSC之后（POST），经验证的评判者识别出11例谵妄患者；医生和护士分别识别出其中8例和10例谵妄患者。医生仅错误地将1例患者识别为谵妄。在医生使用ICDSC之后，医生与经验证的评判者之间的一致性得到改善（PRE卡方=-0.14[95%置信区间{CI}=-0.27至-0.02]至POST卡方=0.67[95%CI=0.38至0.96]），医生与护士之间的一致性也得到改善（PRE卡方=-0.15[95%CI=-0.29至-0.02]至POST卡方=0.58[95%CI=0.25至0.91]）。在两个阶段，护士与经验证的评判者之间的一致性都很强（PRE卡方=0.65[95%CI=0.29至1.00]和POST卡方=0.92[95%CI=0.76至1.00]）。
使用ICDSC并辅以支持其使用的培训，可提高医生在医学重症监护病房检测谵妄的能力。
Zotero 插件