Department of Clinical Gerontology, Clinical Age Research Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, Bessemer Road, London, UK.
Int J Geriatr Psychiatry. 2009 Nov;24(11):1251-6. doi: 10.1002/gps.2254.
The aim of this study was to assess and compare the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS) in the detection of delirium in the acute stroke setting, when used by a non-psychiatrist doctor.
Consecutive participants within 4 days of an acute stroke were screened for delirium using the CAM and the DRS. Patients also had a Mini-Mental State Examination at each assessment. Patients were screened weekly for a maximum of 4 weeks. The CAM and DRS were compared against each other with respect to agreement and applicability.
Of 110 eligible patients, 82 were recruited over a 7 month period. Delirium developed in 23 patients (28%), 21 of whom developed delirium during week 1. We found high agreement between the CAM and the DRS in the detection of stroke in the acute stroke setting (kappa values 0.97, 0.86, 0.79 and 1 at weeks 1, 2, 3 and 4, respectively). In addition, there was strong correlation between low MMSE scores (MMSE less that 10) and delirium (kappa scores 1.0, 0.82, 0.83 and 1.0 at weeks 1, 2, 3 and 4, respectively).
Delirium is a common complication post-stroke. The CAM is equivalent to the DRS in the acute stroke setting when used by a trained non-psychiatrist. A low MMSE score may have a small benefit in identifying patients that are at risk of having delirium.
本研究旨在评估和比较非精神科医生使用的意识混乱评估法（CAM）和谵妄评定量表（DRS）在急性脑卒中环境中检测谵妄的效果。
在急性脑卒中后 4 天内，使用 CAM 和 DRS 对连续患者进行谵妄筛查。患者在每次评估时也进行简易精神状态检查（MMSE）。对患者进行每周最多 4 周的筛查。CAM 和 DRS 之间的比较涉及一致性和适用性。
在 110 名合格患者中，在 7 个月的时间内招募了 82 名患者。23 名患者（28%）出现了谵妄，其中 21 名患者在第 1 周出现了谵妄。我们发现 CAM 和 DRS 在急性脑卒中环境中检测脑卒中的一致性很高（kappa 值分别为 0.97、0.86、0.79 和 1，分别在第 1、2、3 和 4 周）。此外，MMSE 评分较低（MMSE 评分低于 10）与谵妄之间存在强烈相关性（kappa 值分别为 1.0、0.82、0.83 和 1.0，分别在第 1、2、3 和 4 周）。
谵妄是脑卒中后常见的并发症。当由受过训练的非精神科医生使用时，CAM 与 DRS 在急性脑卒中环境中等效。MMSE 评分较低可能有助于识别有发生谵妄风险的患者。
