Silver Gabrielle, Kearney Julia, Traube Chani, Atkinson Thomas M, Wyka Katarzyna E, Walkup John
Weill Cornell Medical College,New York,New York.
Memorial Sloan-Kettering Cancer Center,New York,New York.
Palliat Support Care. 2015 Jun;13(3):513-6. doi: 10.1017/S1478951514000212. Epub 2014 Apr 24.
Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.
Critically ill patients (N = 17), 0-21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual-IV (DSM-IV) (comparable to DSM-V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.
Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81-1.00).
In our study cohort, the psychiatric interview and exam, long considered the "gold standard" in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.
我们的目的是评估儿童精神科医生对小儿谵妄诊断的评分者间信度。
对17名0至21岁的危重病患者进行评估，其中包括7名婴儿、5名发育迟缓儿童和7名插管儿童，使用《精神疾病诊断与统计手册》第四版（DSM-IV）（与DSM-V相当）标准评估谵妄。谵妄评估由两名精神科医生完成，他们互相不知道对方的诊断结果，并使用科恩κ系数及其95%置信区间来测量评分者间信度。
精神科评估的评分者间信度较高（科恩κ = 0.94，CI [0.83, 1.00]）。无论年龄、发育迟缓或插管状态如何，谵妄诊断均显示出极好的评分者间信度（科恩κ范围为0.81 - 1.00）。
在我们的研究队列中，长期以来被视为谵妄诊断“金标准”的精神科访谈和检查具有高度可靠性，即使在极小的、危重病的和发育迟缓的儿童中也是如此。建议采用发展性方法对这一具有挑战性的人群进行谵妄诊断。
