Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK; Edinburgh Delirium Research Group, Royal Infirmary of Edinburgh, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Dalnair Street, Glasgow G3 8SJ, UK.
J Crit Care. 2018 Dec;48:104-111. doi: 10.1016/j.jcrc.2018.08.019. Epub 2018 Aug 21.
Delirium in the ICU is under-diagnosed. We evaluated feasibility and performance of a novel smartphone-based test for objectively detecting inattention in delirium.
DelApp-ICU combines a behavioural assessment and an attention task, whereby participants follow simple commands and count serially presented circles (score range 0-12, lower scores indicating worse performance). We assessed feasibility through staff interviews. Then we performed a preliminary case-control study in patients with and without delirium (ascertained with the Confusion Assessment Method for the ICU) who underwent the DelApp-ICU on up to 4 days.
Forty-six patients (median age = 57.5 years, range 18-83) were assessed 89 times in total (N's = 46, 29, 10 and 4 for subsequent assessments; 33.7% delirious). DelApp-ICU scores were lower in delirium (N = 20; median = 0.5, Inter-Quartile Range (IQR) = 0-4.75) compared to no delirium (N = 26, median = 12, IQR = 8-12) on days 1, 2 and 3 (p < 0.001, p < 0.001 and p < 0.05, respectively). A DelApp-ICU score ≤6 was 100% sensitive and 96% specific to delirium on day 1. Positive and Negative Predictive Values were 91% and 100%, respectively. DelApp-ICU scores were responsive to changes in CAM-ICU status.
DelApp-ICU shows promise for assessing inattention and delirium in ICU patients, including longitudinally monitoring deficits and providing a metric of delirium severity.
重症监护病房（ICU）中的谵妄常常被漏诊。我们评估了一种新型基于智能手机的测试，用于客观检测谵妄患者注意力不集中的可行性和性能。
DelApp-ICU 结合了行为评估和注意力任务，患者根据简单的指令进行操作，并依次对呈现的圆圈进行计数（得分范围 0-12，得分越低表示表现越差）。我们通过与工作人员的访谈评估了可行性。然后，我们对有或无谵妄（采用 ICU 意识模糊评估法进行评估）的患者进行了初步的病例对照研究，这些患者在多达 4 天的时间里接受了 DelApp-ICU 测试。
共有 46 名患者（中位数年龄为 57.5 岁，范围 18-83 岁）总共接受了 89 次评估（N's=46, 29, 10 和 4 分别用于后续评估；33.7%患有谵妄）。DelApp-ICU 评分在第 1、2 和 3 天，谵妄患者（N=20；中位数=0.5，四分位距（IQR）=0-4.75）显著低于无谵妄患者（N=26，中位数=12，IQR=8-12）（p<0.001，p<0.001 和 p<0.05）。DelApp-ICU 评分≤6 在第 1 天对谵妄的敏感性为 100%，特异性为 96%。阳性和阴性预测值分别为 91%和 100%。DelApp-ICU 评分对 CAM-ICU 状态的变化敏感。
DelApp-ICU 有望用于评估 ICU 患者的注意力不集中和谵妄，包括对缺陷的纵向监测以及提供谵妄严重程度的指标。
