van Velthuijsen Eveline L, Zwakhalen Sandra M G, Warnier Ron M J, Mulder Wubbo J, Verhey Frans R J, Kempen Gertrudis I J M
CAPHRI School for Public Health and Primary Care and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Int J Geriatr Psychiatry. 2016 Sep;31(9):974-89. doi: 10.1002/gps.4441. Epub 2016 Feb 21.
Delirium is a serious and common complication among older hospitalized patients and is a predictor of many adverse outcomes. However, up to 72% of delirium incidents are unrecognized or misdiagnosed. The aim of this systematic review is to determine the validity, reliability, and feasibility of instruments for the detection of delirium in older hospitalized patients.
A systematic literature search was conducted. The inclusion criteria were a mean or median age of 65+ years, the use of the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases-10 as a reference standard, and publication in English. All included studies underwent a quality assessment (QUADAS-2).
Forty-three of the 3.790 identified studies were relevant to the review, describing 28 instruments. Quality assessment resulted in 37 studies with a positive quality assessment, describing 23 instruments. Five instruments (Delirium Observation Scale (DOS), Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method (CAM), CAM-Intensive Care Unit (ICU), and Delirium Rating Scale-Revised-98) were described in three or more methodologically sound studies. The Delirium Observation Screening Scale (DOS) and Nu-DESC are observational instruments with good psychometric properties, but the Nu-DESC is shorter and has been validated in more languages. The CAM, CAM-ICU, and Delirium Rating Scale-Revised-98 (DRS-R-98) are instruments with both observational and interactive components. The CAM is the most widely studied and demonstrates the best psychometric properties.
Timely detection of delirium might reduce the negative outcomes of delirium in the long term. The Nu-DESC and CAM appear to be the most adequate instruments for detecting delirium. Copyright © 2016 John Wiley & Sons, Ltd.
谵妄是老年住院患者中一种严重且常见的并发症，是多种不良结局的预测指标。然而，高达72%的谵妄事件未被识别或误诊。本系统评价的目的是确定用于检测老年住院患者谵妄的工具的有效性、可靠性和可行性。
进行了系统的文献检索。纳入标准为平均或中位年龄65岁及以上，使用《精神疾病诊断与统计手册》或《国际疾病分类-10》作为参考标准，并以英文发表。所有纳入研究均进行了质量评估（QUADAS-2）。
在3790项已识别研究中，43项与本评价相关，描述了28种工具。质量评估结果显示，37项研究质量评估为阳性，描述了23种工具。五项工具（谵妄观察量表（DOS）、护理谵妄筛查量表（Nu-DESC）、意识模糊评估法（CAM）、CAM-重症监护病房（ICU）和谵妄评定量表修订版-98）在三项或更多方法学合理的研究中被描述。谵妄观察筛查量表（DOS）和Nu-DESC是具有良好心理测量特性的观察性工具，但Nu-DESC更简短且已在更多语言中得到验证。CAM、CAM-ICU和谵妄评定量表修订版-98（DRS-R-98）是兼具观察和互动成分的工具。CAM是研究最广泛且心理测量特性最佳的工具。
及时检测谵妄可能会长期减少谵妄的负面后果。Nu-DESC和CAM似乎是检测谵妄的最合适工具。版权所有©2016约翰威立父子有限公司。
