Department of Neurology and Neuroscience, Medical Center, University of Freiburg, Freiburg, Germany.
Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Intern Emerg Med. 2019 Aug;14(5):767-776. doi: 10.1007/s11739-018-1989-5. Epub 2018 Nov 27.
Detecting delirium in elderly emergency patients is critical to their outcome. The Nursing Delirium Screening Scale (Nu-DESC) is a short, feasible instrument that allows nurses to systematically screen for delirium. This is the first study to validate the Nu-DESC in a German emergency department (ED). The Nu-DESC was implemented in a high-volume, interdisciplinary German ED. A consecutively recruited sample of medical patients aged ≥ 70 years was screened by assigned nurses who performed the Nu-DESC as part of their daily work routine. The results were compared to a criterion standard diagnosis of delirium. According to the criterion standard diagnosis, delirium was present in 47 (14.9%) out of the 315 patients enrolled. The Nu-DESC shows a good specificity level of 91.0% (95% CI 87.0-94.2), but a moderate sensitivity level of 66.0% (95% CI 50.7-79.1). Positive and negative likelihood ratios are 7.37 (95% CI 4.77-11.36) and 0.37 (95% CI 0.25-0.56), respectively. In an exploratory analysis, we find that operationalizing the Nu-DESC item "disorientation" by specifically asking patients to state the day of the week and the name of the hospital unit would raise Nu-DESC sensitivity to 77.8%, with a specificity of 84.6% (positive and negative likelihood ratio of 5.05 and 0.26, respectively). The Nu-DESC shows good specificity but moderate sensitivity when performed by nurses during their daily work in a German ED. We have developed a modified Nu-DESC version, resulting in markedly enhanced sensitivity while maintaining a satisfactory level of specificity.
在老年急诊患者中检测谵妄对其结果至关重要。护理谵妄筛查量表（Nu-DESC）是一种简短、可行的工具，可让护士系统地筛查谵妄。这是第一项在德国急诊科验证 Nu-DESC 的研究。Nu-DESC 在一家高容量的跨学科德国急诊科实施。通过指定护士对年龄≥70 岁的连续入组的内科患者进行筛查，这些护士在日常工作中执行 Nu-DESC。结果与谵妄的标准诊断进行比较。根据标准诊断，315 名入组患者中有 47 名（14.9%）存在谵妄。Nu-DESC 显示出良好的特异性水平为 91.0%（95%CI 87.0-94.2），但敏感性为 66.0%（95%CI 50.7-79.1）。阳性和阴性似然比分别为 7.37（95%CI 4.77-11.36）和 0.37（95%CI 0.25-0.56）。在一项探索性分析中，我们发现通过具体询问患者说出星期几和医院科室名称来操作 Nu-DESC 项目“定向障碍”，可以将 Nu-DESC 的敏感性提高到 77.8%，特异性为 84.6%（阳性和阴性似然比分别为 5.05 和 0.26）。在德国急诊科，护士在日常工作中执行 Nu-DESC 时，特异性较好，但敏感性中等。我们开发了一种改良的 Nu-DESC 版本，在保持满意特异性水平的同时显著提高了敏感性。
