Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, University of Leeds, Bradford, UK.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, UK.
Age Ageing. 2018 Jan 1;47(1):56-61. doi: 10.1093/ageing/afx155.
care home residents are particularly at risk of delirium due to high prevalence of dementia. The Delirium Observation Screening Scale (DOSS) identifies behavioural changes associated delirium onset that nursing staff are uniquely placed to recognise. We tested the psychometric properties of the DOSS in UK care homes compared with the Confusion Assessment Method (CAM).
prospective observational cohort study performed between 1 March 2015 and 30 June 2016.
nine UK residential and nursing care homes.
residents over 65 years except those approaching end of life or unable to complete delirium assessments.
the 25-item DOSS was completed daily by care home staff and compared with the temporally closest CAM performed twice per week by trained researchers. Sensitivity, specificity, positive and negative predictive values, diagnostic odds and likelihood ratios were calculated.
216 residents participated; mean age 84.9 (SD 7.9); 50% had cognitive impairment (median AMTS 7 (IQR 3-9)). Half of all expected DOSS assessments occurred (30,201); of these, 11,659 (39%) were complete. 78 positive CAM measurements were made during 71 delirium episodes in 45 residents over 70 weeks. Sensitivity and specificity for delirium detection were optimised at a DOSS cut point of ≥5 (sensitivity 0.61 (95% CI: 0.39-0.80) and specificity (0.71 95% CI: 0.70-0.73)). Positive and negative predictive values were 1.6 and 99.5%, respectively.
the low sensitivity of the DOSS limits clinical utility for detection of delirium as part of routine care for care home residents, although a negative DOSS affords confidence that delirium is not present.
由于痴呆症的高患病率，护理院居民尤其容易出现谵妄。谵妄观察筛查量表（DOSS）可识别与谵妄发作相关的行为变化，而护理人员则具有独特的识别能力。我们在英国护理院对 DOSS 的心理测量特性进行了测试，与意识混乱评估方法（CAM）进行了比较。
2015 年 3 月 1 日至 2016 年 6 月 30 日期间进行的前瞻性观察队列研究。
9 家英国住宿和护理院。
年龄超过 65 岁的居民，除非接近生命末期或无法完成谵妄评估。
护理院工作人员每天完成 25 项 DOSS 评估，并与每周两次由经过培训的研究人员进行的时间最接近的 CAM 进行比较。计算了敏感性、特异性、阳性和阴性预测值、诊断优势比和似然比。
216 名居民参与；平均年龄 84.9（SD 7.9）；50%有认知障碍（中位数 AMTS 7（IQR 3-9））。完成了所有预期 DOSS 评估的一半（30,201）；其中，11,659（39%）完成。在 70 周内 45 名年龄超过 70 岁的患者中，共发生了 78 次阳性 CAM 测量和 71 次谵妄发作。DOSS 切点≥5 时，检测谵妄的敏感性和特异性最佳（敏感性 0.61（95%CI：0.39-0.80）和特异性 0.71（95%CI：0.70-0.73））。阳性和阴性预测值分别为 1.6 和 99.5%。
DOSS 的敏感性较低，限制了其作为护理院居民常规护理一部分检测谵妄的临床实用性，尽管 DOSS 为阴性可确认谵妄不存在。
