Primary Healthcare Centre Buenos Aires, Madrid, Spain; Primary Healthcare, Madrid, Spain; Palliative Care Unit, Fundación Jiménez Díaz, Madrid, Spain; Palliative Care Support Team, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
Primary Healthcare Centre Buenos Aires, Madrid, Spain; Primary Healthcare, Madrid, Spain; Palliative Care Unit, Fundación Jiménez Díaz, Madrid, Spain; Palliative Care Support Team, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
J Pain Symptom Manage. 2018 Mar;55(3):968-972. doi: 10.1016/j.jpainsymman.2017.11.013. Epub 2017 Nov 16.
Although Memorial Delirium Assessment Scale (MDAS) is a successful tool for delirium evaluation and monitoring, it is nevertheless important to determine whether cutoff scores vary according to the studied population. The main objective of this study was to evaluate the diagnostic sensitivity of the recently validated Spanish version of the MDAS. The secondary objective was to analyze possible diagnostic differences when used in a hospice or general hospital setting.
A prospective study was conducted with advanced cancer patients in two settings (hospice and general hospital). A diagnosis of delirium was established according to clinical criteria and the Confusion Assessment Method. Sensitivity (S), specificity (Sp), positive predictive value, and negative predictive value were determined according to the receiver operating characteristics curve. The MDAS values for different centers were studied using nonparametric tests (Mann-Whitney).
A total of 67 patients were included, 28 of whom had been diagnosed with delirium (15/40 hospice and 13/27 general hospital). The mean MDAS scores were 13.6 and 5.5 for the delirium and nondelirium groups, respectively. A cutoff score of 7 gave the optimal screening diagnosis balance (S 92.6%, Sp 71.8%, positive predictive value 70.1%, and negative predictive value 93.3%). Diagnoses of anxiety and depression were not related with delirium (P ≤ 0.44). A diagnosis of dementia was related to delirium (P ≤ 0.052) but did not influence the diagnostic sensitivity of MDAS (P ≤ 0.26). No differences were found between hospice and general hospital settings as regards the diagnostic sensitivity of MDAS.
A screening cutoff of 7 appears to be optimal for MDAS Spanish version. No differences were found between advanced cancer patients cared for in a hospice or general hospital. However, more research is required to define the MDAS cutoff for patients with advanced cancer and dementia.
尽管《纪念谵妄评估量表》（MDAS）是评估和监测谵妄的有效工具，但确定其截断分数是否因研究人群而异仍然很重要。本研究的主要目的是评估最近验证的 MDAS 西班牙语版本的诊断灵敏度。次要目的是分析在临终关怀或综合医院环境中使用时可能存在的诊断差异。
在临终关怀和综合医院两个环境中进行了前瞻性研究。根据临床标准和意识模糊评估方法确定谵妄诊断。根据接收者操作特征曲线确定灵敏度（S）、特异性（Sp）、阳性预测值和阴性预测值。使用非参数检验（Mann-Whitney）研究不同中心的 MDAS 值。
共纳入 67 例患者，其中 28 例被诊断为谵妄（40 例临终关怀中有 15 例，27 例综合医院中有 13 例）。谵妄组和非谵妄组的 MDAS 评分分别为 13.6 和 5.5。截断分数为 7 时，筛查诊断的平衡最佳（S 为 92.6%，Sp 为 71.8%，阳性预测值为 70.1%，阴性预测值为 93.3%）。焦虑和抑郁诊断与谵妄无关（P≤0.44）。痴呆诊断与谵妄相关（P≤0.052），但不影响 MDAS 的诊断灵敏度（P≤0.26）。临终关怀和综合医院环境之间在 MDAS 的诊断灵敏度方面没有差异。
MDAS 西班牙语版本的截断分数为 7 似乎是最佳的。在临终关怀和综合医院接受治疗的晚期癌症患者之间没有发现差异。但是，需要进一步研究来确定患有晚期癌症和痴呆的患者的 MDAS 截断分数。
