Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
Cork University Hospital, Cork, Ireland.
J Neurol Neurosurg Psychiatry. 2014 Oct;85(10):1122-31. doi: 10.1136/jnnp-2013-307053. Epub 2014 Feb 25.
Routine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective 'confusion'.
We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method.
265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cut-off 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity.
Our results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.
常规谵妄筛查可以提高谵妄的检出率，但目前尚不清楚哪种筛查工具最合适。我们测试了以下几种筛查方法（单独或联合使用）对谵妄的诊断准确性：月份倒推测试（MOTYB）；顺向空间广度测试（SSF）；主观或客观“混乱”的证据。
我们对一家大型三级转诊医院的成年住院患者进行了横断面研究。初级医务人员对筛查测试进行了测试。随后，进行了两次独立的正式谵妄评估：首先是使用意识混乱评估法（CAM），然后是修订版 98 项谵妄评定量表（DRS-R98）。采用《精神障碍诊断与统计手册》第四版（DSM-IV）标准进行诊断。计算了每种筛查方法的敏感性和特异性比值及其 95%置信区间（CI）。
共纳入 265 例患者。总体而言，最精确的筛查方法是同时进行 MOTYB 和主观/客观混乱评估（敏感性 93.8%，95%CI 82.8 至 98.6；特异性 84.7%，95%CI 79.2 至 89.2）。在老年患者中，单独使用 MOTYB 最准确，而在年轻患者中，同时结合 SSF（临界值 4）和 MOTYB 或主观/客观混乱评估是最佳的。在所有情况下，添加 CAM 作为提高特异性的二线筛查步骤都会导致敏感性显著下降。
我们的结果表明，简单的注意力测试可能对谵妄筛查有用。MOTYB 单独使用是老年人最准确的筛查测试。
