急诊科社区老年人认知障碍筛查中O3DY法语版（O3DY-F）的验证

Validation of the O3DY French Version (O3DY-F) for the Screening of Cognitive Impairment in Community Seniors in the Emergency Department.

作者信息

Bédard Catherine, Boucher Valerie, Voyer Philippe, Yadav Krishan, Eagles Debra, Nadeau Alexandra, Carmichael Pierre-Hugues, Pelletier Mathieu, Gouin Emilie, Berthelot Simon, Daoust Raoul, Laguë Antoine, Gagné Anne-Julie, Émond Marcel

机构信息

Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Québec, Canada; Université Laval, Québec, Canada; Centre d'excellence sur le vieillissement de Québec, Québec, Canada; Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval (CERSSPL-UL), Québec, Canada.

Université Laval, Québec, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada.

出版信息

J Emerg Med. 2019 Jul;57(1):59-65. doi: 10.1016/j.jemermed.2019.02.007. Epub 2019 Apr 22.

DOI:10.1016/j.jemermed.2019.02.007

PMID:31023635

Abstract

BACKGROUND

It is recommended that older patients undergo systematic mental status screening when presenting to the emergency department (ED). However, the tools available are not necessarily adapted to the ED environment, therefore, quicker and easier tools are needed.

OBJECTIVES

The purpose of this study is to validate the Ottawa 3DY-French (O3DY-F) Scale as a screening tool for delirium and cognitive impairment in a French-speaking cohort.

METHOD

This multicenter prospective study was conducted in four hospitals across the province of Quebec. Inclusion criteria were: age ≥ 65 years, ED stay ≥ 8 h, awaiting admission to a care unit, and independent or semi-independent in their daily living activities. Cognitive status was assessed during the initial interview using the Telephone Interview for Cognitive Screening-modified (TICS-m) and the O3DY-F scale. Comparisons were made between the O3DY-F and the TICS-m and Confusion Assessment Method (CAM) to assess the sensitivity and specificity of the O3DY-F for the detection of cognitive impairment and delirium.

RESULTS

A total of 313 patients were included in this study, 139 of which had a positive O3DY-F. When compared with the CAM, the O3DY-F had a sensitivity of 84.2% (95% confidence interval [CI] 60.4-96.6) and a specificity of 58.2% (95% CI 52.3-63.9) for the detection of prevalent delirium. The O3DY-F had a sensitivity of 76.2% (95% CI 66.7-84.8) and a specificity of 67.6% (95% CI 61.0-73.6) for cognitive impairment (defined as a TICS-m < 27).

CONCLUSION

The O3DY-F is a useful and effective tool to screen for delirium and undetected cognitive impairment among a French-speaking cohort in the ED.

摘要

背景

建议老年患者在前往急诊科（ED）就诊时接受系统的精神状态筛查。然而，现有的工具不一定适用于急诊科环境，因此，需要更快、更简便的工具。

目的

本研究旨在验证渥太华3DY-法语（O3DY-F）量表作为法语队列中谵妄和认知障碍筛查工具的有效性。

方法

本多中心前瞻性研究在魁北克省的四家医院进行。纳入标准为：年龄≥65岁、在急诊科停留≥8小时、等待入住护理单元、日常生活活动独立或半独立。在初次访谈期间，使用改良的认知筛查电话访谈（TICS-m）和O3DY-F量表评估认知状态。比较O3DY-F与TICS-m以及谵妄评估方法（CAM），以评估O3DY-F检测认知障碍和谵妄的敏感性和特异性。

结果

本研究共纳入313例患者，其中139例O3DY-F结果为阳性。与CAM相比，O3DY-F检测现患谵妄的敏感性为84.2%（95%置信区间[CI]60.4-96.6），特异性为58.2%（95%CI52.3-63.9）。O3DY-F检测认知障碍（定义为TICS-m<27）的敏感性为76.2%（95%CI66.7-84.8），特异性为67.6%（95%CI61.0-73.6）。