Shi Qiyun, Warren Laura, Saposnik Gustavo, Macdermid Joy C
Health and Rehabilitation Sciences, Western University, London, Ontario, Canada ; Stroke Outcomes Research Center, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Neuropsychiatr Dis Treat. 2013;9:1359-70. doi: 10.2147/NDT.S49520. Epub 2013 Sep 19.
Delirium is common in the early stages of hospitalization for a variety of acute and chronic diseases.
To evaluate the diagnostic accuracy of two delirium screening tools, the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
We searched MEDLINE, EMBASE, and PsychInfo for relevant articles published in English up to March 2013. We compared two screening tools to Diagnostic and Statistical Manual of Mental Disorders IV criteria. Two reviewers independently assessed studies to determine their eligibility, validity, and quality. Sensitivity and specificity were calculated using a bivariate model.
Twenty-two studies (n = 2,442 patients) met the inclusion criteria. All studies demonstrated that these two scales can be administered within ten minutes, by trained clinical or research staff. The pooled sensitivities and specificity for CAM were 82% (95% confidence interval [CI]: 69%-91%) and 99% (95% CI: 87%-100%), and 81% (95% CI: 57%-93%) and 98% (95% CI: 86%-100%) for CAM-ICU, respectively.
Both CAM and CAM-ICU are validated instruments for the diagnosis of delirium in a variety of medical settings. However, CAM and CAM-ICU both present higher specificity than sensitivity. Therefore, the use of these tools should not replace clinical judgment.
谵妄在各种急慢性疾病住院治疗的早期阶段很常见。
评估两种谵妄筛查工具，即谵妄评定法（CAM）和重症监护病房谵妄评定法（CAM-ICU）的诊断准确性。
我们检索了MEDLINE、EMBASE和PsychInfo数据库，查找截至2013年3月以英文发表的相关文章。我们将两种筛查工具与《精神疾病诊断与统计手册》第四版标准进行比较。两名评审员独立评估研究，以确定其合格性、有效性和质量。使用双变量模型计算敏感性和特异性。
22项研究（n = 2442例患者）符合纳入标准。所有研究均表明，这两种量表可由经过培训的临床或研究人员在10分钟内完成评定。CAM的合并敏感性和特异性分别为82%（95%置信区间[CI]：69%-91%）和99%（95%CI：87%-100%），CAM-ICU的合并敏感性和特异性分别为81%（95%CI：57%-93%）和98%（95%CI：86%-100%）。
CAM和CAM-ICU都是在各种医疗环境中诊断谵妄的有效工具。然而，CAM和CAM-ICU的特异性均高于敏感性。因此，使用这些工具不应取代临床判断。
