Palma Alejandra, Del Río Ignacia, Bonati Pilar, Tupper Laura, Villarroel Luis, Olivares Patricia, Nervi Flavio
Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina, División de Medicina, Pontificia Universidad Católica de Chile, Chile.
Rev Med Chil. 2008 May;136(5):561-9. Epub 2008 Jul 30.
Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback.
To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital.
We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance.
Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%. Pain, restlessness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334.
In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team.
医生往往会高估或低估患者报告的症状。因此，有人提出使用标准化症状评分系统来克服这一缺点。
评估大学医院内科收治患者的身体和心理症状及谵妄的患病率和诊断准确性。
我们研究了58例患者，其中45例为转移性癌症患者，13例为其他晚期慢性病患者。使用了以下量表：用于诊断谵妄的意识模糊评估方法；用于评估疼痛和其他身体症状的埃德蒙顿症状评估量表（ESAS）；用于评估焦虑和抑郁的医院焦虑抑郁量表。ESAS同时应用于无谵妄的患者及其医生，以评估诊断一致性水平。
22%的患者患有谵妄。在45例无谵妄的患者中，11例（25%）至少有8种症状，39例（88.6%）有4种症状。症状的患病率非常高，在22%至78%之间。疼痛、烦躁不安、厌食和睡眠障碍最为常见。患者报告的症状与医生记录的症状之间的一致性非常低，kappa指数在0.001至0.334之间。
在我们的慢性病样本中，心理和身体症状的发生率非常高，而医疗团队对这些症状的记录不足。
