用于重症监护病房谵妄诊断的重症监护病房意识模糊评估方法（CAM-ICU）和重症监护谵妄筛查清单（ICDSC）：临床研究的系统评价和荟萃分析

INTRODUCTION

Delirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients.

METHODS

A systematic review was conducted to identify articles on the evaluation of the CAM-ICU and the ICDSC in ICU patients. A MEDLINE, SciELO, CINAHL and EMBASE databases search was performed for articles published in the English language, involving adult populations and comparing these diagnostic tools with the gold standard, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results were summarized by meta-analysis. The QUADAS scale was used to assess the quality of the studies.

RESULTS

Nine studies evaluating the CAM-ICU (including 969 patients) and four evaluating the ICDSC (n = 361 patients) were included in the final analysis. The pooled sensitivity of the CAM-ICU was 80.0% (95% confidence interval (CI): 77.1 to 82.6%), and the pooled specificity was 95.9% (95% CI: 94.8 to 96.8%). The diagnostic odds ratio was 103.2 (95% CI: 39.6 to 268.8). The pooled area under the summary receiver operating characteristic curve (AUC) was 0.97. The pooled sensitivity of the ICDSC was 74% (95% CI: 65.3 to 81.5%), and the pooled specificity was 81.9% (95% CI: 76.7 to 86.4%). The diagnostic odds ratio was 21.5 (95% CI: 8.51 to 54.4). The AUC was 0.89.

CONCLUSIONS

The CAM-ICU is an excellent diagnostic tool in critically ill ICU patients, whereas the ICDSC has moderate sensitivity and good specificity. The available data suggest that both CAM-ICU and the ICDSC can be used as a screening tool for the diagnosis of delirium in critically ill patients.

引言

谵妄是重症患者急性脑功能障碍的常见形式，针对此已开发出多种检测工具用于重症监护病房（ICU）。本研究的目的是评估重症监护病房意识模糊评估法（CAM-ICU）和重症监护谵妄筛查清单（ICDSC）在诊断重症患者谵妄方面准确性的现有证据。

方法

进行了一项系统评价，以确定有关评估ICU患者中CAM-ICU和ICDSC的文章。对MEDLINE、SciELO、CINAHL和EMBASE数据库进行检索，查找以英文发表的涉及成年人群并将这些诊断工具与金标准《精神疾病诊断与统计手册》（DSM-IV）标准进行比较的文章。结果通过荟萃分析进行总结。采用QUADAS量表评估研究质量。

结果

最终分析纳入了9项评估CAM-ICU的研究（包括969例患者）和4项评估ICDSC的研究（n = 361例患者）。CAM-ICU的合并敏感度为80.0%（95%置信区间（CI）：77.1%至82.6%），合并特异度为95.9%（95%CI：94.8%至96.8%）。诊断比值比为103.2（95%CI：39.6至268.8）。汇总的受试者工作特征曲线下面积（AUC）为0.97。ICDSC的合并敏感度为74%（95%CI：65.3%至81.5%），合并特异度为81.9%（95%CI：76.7%至86.4%）。诊断比值比为21.5（95%CI：8.51至54.4）。AUC为0.89。