Pendlebury Sarah T, Lovett Nicola, Smith Sarah C, Cornish Emily, Mehta Ziyah, Rothwell Peter M
NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK Departments of General (Internal) Medicine and Geratology, John Radcliffe hospital, Oxford, UK Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford OX3 9DU, UK.
Departments of General (Internal) Medicine and Geratology, John Radcliffe hospital, Oxford, UK Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford OX3 9DU, UK.
Age Ageing. 2016 Jan;45(1):60-5. doi: 10.1093/ageing/afv177.
reliable delirium risk stratification will aid recognition, anticipation and prevention and will facilitate targeting of resources in clinical practice as well as identification of at-risk patients for research. Delirium risk scores have been derived for acute medicine, but none has been prospectively validated in external cohorts. We therefore aimed to determine the reliability of externally derived risk scores in a consecutive cohort of older acute medicine patients.
consecutive patients aged ≥65 over two 8-week periods (2010, 2012) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The reliability of existing delirium risk scores derived in acute medicine cohorts and simplified for use in routine clinical practice (USA, n = 2; Spain, n = 1; Indonesia, n = 1) was determined by the area under the receiver operating characteristic curve (AUC). Delirium was defined as prevalent (on admission), incident (occurring during admission) and any (prevalent + incident) delirium.
among 308 consecutive patients aged ≥65 (mean age/SD = 81/8 years, 164 (54%) female), existing delirium risk scores had AUCs for delirium similar to those reported in their original internal validations ranging from 0.69 to 0.76 for any delirium and 0.73 to 0.83 for incident delirium. All scores performed better than chance but no one score was clearly superior.
externally derived delirium risk scores performed well in our independent acute medicine population with reliability unaffected by simplification and might therefore facilitate targeting of multicomponent interventions in routine clinical practice.
可靠的谵妄风险分层有助于识别、预测和预防谵妄，将便于在临床实践中合理分配资源，并有助于确定研究中的高危患者。急性医学领域已得出谵妄风险评分，但尚无评分在外部队列中得到前瞻性验证。因此，我们旨在确定外部得出的风险评分在一组连续的老年急性医学患者中的可靠性。
在两个为期8周的时间段（2010年、2012年）内，对年龄≥65岁的连续患者使用意识错乱评估法（CAM）进行前瞻性谵妄筛查，并根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断谵妄。通过受试者操作特征曲线下面积（AUC）确定在急性医学队列中得出并简化用于常规临床实践的现有谵妄风险评分的可靠性（美国，n = 2；西班牙，n = 1；印度尼西亚，n = 1）。谵妄被定义为入院时存在的（现患）、入院期间发生的（新发）以及任何（现患+新发）谵妄。
在308例年龄≥65岁的连续患者中（平均年龄/标准差 = 81/8岁，164例（54%）为女性），现有谵妄风险评分对谵妄的AUC与在其原始内部验证中报告的结果相似，任何谵妄的AUC范围为0.69至0.76，新发谵妄的AUC范围为0.73至0.83。所有评分的表现均优于随机水平，但没有一个评分明显更优。
外部得出的谵妄风险评分在我们独立的急性医学人群中表现良好，其可靠性不受简化的影响，因此可能有助于在常规临床实践中针对多组分干预措施。
