Department of Psychiatry and Behavioral Sciences and.
Br J Anaesth. 2013 Oct;111(4):612-8. doi: 10.1093/bja/aet167. Epub 2013 May 8.
Postoperative delirium in the elderly is common and associated with poor outcomes, but often goes unrecognized. Delirium screening tools, validated in postoperative settings are lacking. This study compares two screening tools [Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Nursing Delirium Symptom Checklist (NuDESC)] with a DSM-IV-based diagnosis of delirium, conducted by neuropsychiatric examination in postoperative settings.
Consecutive English-speaking patients, ≥70 yr, undergoing surgery with general anaesthesia and capable of providing informed consent, were recruited. Diagnostic test characteristics were compared for each screening tool vs neuropsychiatric examination, both in the Post-Anaesthesia Care Unit (PACU), and daily during inpatient hospitalization, adjusting for repeated measures.
Neuropsychiatric examination identified delirium in 45% of 91 patients evaluated in the PACU and in 32% of 166 subsequent delirium assessments on the ward in the 58 admitted patients. The sensitivity [95% confidence interval (CI)] of delirium detection of the CAM-ICU in the PACU, and in all repeated assessments was 28% (16-45%) and 28% (17-42%), respectively; for the NuDESC (scoring threshold ≥2), 32% (19-48%) and 29% (19-42%), respectively, and the NuDESC (threshold ≥1), 80% (65-91%) and 72% (60-82%), respectively. Specificity was >90% for both the CAM-ICU and the NuDESC (threshold ≥2); specificity for the NuDESC (threshold ≥1), in the PACU was 69% (54-80%) and 80% (73-85%) for all assessments.
While highly specific, neither CAM-ICU nor NuDESC (threshold ≥2) are adequately sensitive to identify delirium post-operatively; NuDESC (threshold ≥1) increases sensitivity, but reduces specificity.
老年人术后谵妄很常见，且与不良预后相关，但往往未被识别。目前缺乏在术后环境中得到验证的谵妄筛查工具。本研究比较了两种筛查工具[重症监护病房意识模糊评估法（CAM-ICU）和护理谵妄症状检查表（NuDESC）]与基于 DSM-IV 的术后神经精神检查诊断的谵妄，以评估在术后恢复室（PACU）和住院期间每天进行筛查的诊断测试特征。
纳入了 91 例接受全麻手术且能够提供知情同意的、年龄≥70 岁的连续英语患者。调整重复测量后，比较了每个筛查工具与神经精神检查在 PACU 以及在 58 例住院患者的住院病房内后续 166 次谵妄评估中的诊断测试特征。在 PACU 评估的 91 例患者中，神经精神检查确定了 45%存在谵妄，在 166 例随后在住院病房的 58 例患者中进行的 166 次谵妄评估中，有 32%存在谵妄。CAM-ICU 在 PACU 中的谵妄检测灵敏度[95%置信区间（CI）]分别为 28%（16-45%）和 28%（17-42%）；NuDESC（评分阈值≥2）分别为 32%（19-48%）和 29%（19-42%），而 NuDESC（阈值≥1）的灵敏度分别为 80%（65-91%）和 72%（60-82%）。CAM-ICU 和 NuDESC（阈值≥2）的特异性均>90%；NuDESC（阈值≥1）在 PACU 中的特异性为 69%（54-80%）和 80%（73-85%）。
虽然特异性很高，但 CAM-ICU 和 NuDESC（阈值≥2）均不能足够敏感地识别术后谵妄；NuDESC（阈值≥1）增加了灵敏度，但降低了特异性。
