Numan Tianne, van den Boogaard Mark, Kamper Adriaan M, Rood Paul J T, Peelen Linda M, Slooter Arjen J C
Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Intensive Care Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
J Am Geriatr Soc. 2017 Sep;65(9):1932-1938. doi: 10.1111/jgs.14933. Epub 2017 May 12.
To evaluate to what extent delirium experts agree on the diagnosis of delirium when independently assessing exactly the same information and to evaluate the sensitivity of delirium screening tools in routine daily practice of clinical nurses.
Prospective observational longitudinal study.
Three medical centers in the Netherlands.
Elderly postoperative adults (n = 167).
A researcher examined participants daily (Postoperative Day 1-3) for delirium using a standardized cognitive assessment and interview including the Delirium Rating Scale Revised-98 as global impression without any cut-off values that was recorded on video. Two delirium experts independently evaluated the videos and clinical information from the last 24 hours in the participants' record and classified each assessment as delirious, possibly delirious, or not delirious. Interrater agreement between the delirium experts was determined using weighted Cohen's kappa. When there was no consensus, a third expert was consulted. Final classification was based on median score and compared with the results of the Confusion Assessment Method for Intensive Care Unit and Delirium Observation Scale that clinical nurses administered.
Four hundred twenty-four postoperative assessments of 167 participants were included. The overall kappa was 0.61 (95% confidence interval = 0.53-0.68). There was no agreement between the experts for 89 (21.0%) assessments and a third delirium expert was needed for the final classification. Delirium screening that nurses performed detected 32% of the assessments that the experts diagnosed as (possibly) delirious.
There was considerable disagreement in classification of delirium by experts who independently assessed exactly the same information, showing the difficulty of delirium diagnosis. Furthermore, the sensitivity of daily delirium screening by clinical nurses was poor. Future research should focus on development of objective instruments to diagnose delirium.
评估谵妄专家在独立评估完全相同的信息时，对谵妄诊断的一致程度，并评估谵妄筛查工具在临床护士日常实践中的敏感性。
前瞻性观察性纵向研究。
荷兰的三个医疗中心。
老年术后成年人（n = 167）。
一名研究人员在术后第1至3天每天使用标准化认知评估和访谈对参与者进行谵妄检查，包括《谵妄评定量表修订版-98》作为整体印象，无任何临界值，相关情况记录在视频中。两名谵妄专家独立评估视频以及参与者记录中过去24小时的临床信息，并将每次评估分类为谵妄、可能谵妄或无谵妄。使用加权科恩kappa系数确定谵妄专家之间的评分者间一致性。当没有达成共识时，会咨询第三位专家。最终分类基于中位数得分，并与临床护士使用的《重症监护病房谵妄评估方法》和《谵妄观察量表》的结果进行比较。
纳入了167名参与者的424次术后评估。总体kappa系数为0.61（95%置信区间 = 0.53 - 0.68）。专家之间对89次（21.0%）评估没有达成一致，最终分类需要第三位谵妄专家参与。护士进行的谵妄筛查检测到专家诊断为（可能）谵妄的评估中的32%。
独立评估完全相同信息的专家在谵妄分类上存在相当大的分歧，这表明谵妄诊断存在困难。此外，临床护士每日谵妄筛查的敏感性较差。未来的研究应侧重于开发诊断谵妄的客观工具。
