Department of Psychiatry and Psychotherapy,University Hospital of Zurich, University of Zurich,Zurich,Switzerland.
Institute for Regenerative Medicine, University of Zurich,Schlieren,Switzerland.
Palliat Support Care. 2017 Oct;15(5):535-543. doi: 10.1017/S147895151600105X. Epub 2017 Jan 12.
The management of and prognosis for delirium are affected by its subtype: hypoactive, hyperactive, mixed, and none. The DMSS-4, an abbreviated version of the Delirium Motor Symptom Scale, is a brief instrument for the assessment of delirium subtypes. However, it has not yet been evaluated in an intensive care setting.
We performed a prospective/descriptive cohort study in order to determine the internal consistency, reliability, and validity of the relevant items of the DMSS-4 versus the Delirium Rating Scale-Revised-98 (DRS-R-98) and the original DMSS in a surgical intensive care setting.
A total of 289 elderly, predominantly male patients were screened for delirium, and 122 were included in our sample. The internal consistency of the DMSS-4 items was excellent (Cronbach's α = 0.92), and between the DMSS-4 and DRS-R-98 the overall concurrent validity was substantial (Cramer's V = 0.67). Within individual motor subtypes, concurrent validity remained at least substantial (Cohen's κ = 0.65-0.81) and sensitivity high (69.8 to 82.2%), in contrast to those of the no-motor subtype, with less validity and sensitivity (κ = 0.28, 22%). Similarly, total concurrent validity between the DMSS-4 and the original DMSS reached perfection (Cramer's V = 0.83), as did agreement between the subtypes (κ = 0.83-0.92), while sensitivity remained high (88.2-100%). Only in those with delirium with no-motor subtype was agreement moderate (κ = 0.56) and sensitivity lower (67%). Specificity was high across all subtypes (91.2-99.1%). The DMSS-4 yielded very sensitive ratings, particularly for hypoactive and hyperactive motor symptoms, and interrater agreement was excellent (Fleiss's κ = 0.83).
We found the DMSS-4 to be a most reliable and valid brief assessment of delirium in characterizing the subtypes of delirium in an intensive care setting, with increased sensitivity to hypoactive and hyperactive motor alterations.
谵妄的管理和预后受其亚型的影响：低活动型、高活动型、混合性和非运动型。DMSS-4 是 Delirium Motor Symptom Scale 的缩写版，是一种用于评估谵妄亚型的简短工具。然而，它尚未在重症监护环境中进行评估。
我们进行了一项前瞻性/描述性队列研究，以确定 DMSS-4 与修订后的 98 版 Delirium Rating Scale（DRS-R-98）和原始 DMSS 的相关项目在外科重症监护环境中的内部一致性、可靠性和有效性。
共对 289 名老年、主要为男性的患者进行了谵妄筛查，其中 122 名患者纳入了我们的样本。DMSS-4 项目的内部一致性非常好（Cronbach's α = 0.92），DMSS-4 与 DRS-R-98 之间的整体同期有效性为实质性（Cramer's V = 0.67）。在各个运动亚型内，同期有效性至少为实质性（Cohen's κ = 0.65-0.81），敏感性高（69.8%至 82.2%），而无运动亚型的同期有效性和敏感性较低（κ = 0.28，22%）。同样，DMSS-4 与原始 DMSS 之间的总同期有效性达到完美（Cramer's V = 0.83），亚型之间的一致性也是如此（κ = 0.83-0.92），敏感性仍然很高（88.2%-100%）。只有在无运动亚型的谵妄患者中，一致性为中度（κ = 0.56），敏感性较低（67%）。所有亚型的特异性均较高（91.2%-99.1%）。DMSS-4 产生了非常敏感的评分，特别是对低活动型和高活动型运动症状，且评分者间的一致性非常好（Fleiss's κ = 0.83）。
我们发现，DMSS-4 是一种非常可靠和有效的工具，可以用于在重症监护环境中对谵妄亚型进行特征描述，对低活动型和高活动型运动改变具有更高的敏感性。
