From the Department of Anesthesiology and Operative Intensive Care Medicine (MO, SE, RM, CDS) and Institute of Biometry and Clinical Epidemiology (JK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Institute of Health (BIH), Berlin, Germany (MO, JK).
Eur J Anaesthesiol. 2019 Sep;36(9):683-687. doi: 10.1097/EJA.0000000000001048.
Recent guidelines on postoperative delirium (POD) recommend POD screening in all patients, using a validated tool, starting in the recovery room. An operationalisation of the Confusion Assessment Method (CAM) criteria, the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM), has been developed for use in general medical units.
The aim of this study was to evaluate 3D-CAM performance in an adult patient population to detect POD in the recovery room.
A prospective diagnostic study.
Recovery room of a tertiary care university hospital in Berlin, Germany, in 2017.
Patients at least 18 years of age undergoing elective surgery.
Patients were subjected to evaluation by blinded investigators using the 3D-CAM and the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5, reference standard). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were analysed for 3D-CAM, in addition to test-retest and inter-rater reliability analyses.
Sixteen out of 176 patients (9.1%) developed POD. The 3D-CAM demonstrated strong test performance (specificity 0.88, sensitivity 1.0, area under the curve 0.94, PPV 0.44 and NPV 1.0), with a test-retest reliability of 90% (n = 10) and inter-rater reliability of 80% (n = 10).
In this diagnostic study, 3D-CAM showed strong performance for detection of POD in the recovery room. Due to the low training requirements, fast application and high sensitivity, it might be particularly appropriate for clinical staff with limited experience in the assessment of POD.
ClinicalTrials.gov Identifier: NCT02992717.
最近关于术后谵妄（POD）的指南建议对所有患者进行 POD 筛查，使用经过验证的工具，从恢复室开始。为了在一般医疗单位使用，已经制定了《意识模糊评估法》（CAM）标准的操作方法，即 3 分钟 CAM 定义的谵妄诊断访谈（3D-CAM）。
本研究旨在评估 3D-CAM 在成年患者人群中的表现，以检测恢复室中的 POD。
前瞻性诊断研究。
德国柏林一所三级护理大学医院的恢复室，2017 年。
年龄至少 18 岁，接受择期手术。
盲法研究人员使用 3D-CAM 和《精神障碍诊断与统计手册 5 版》（DSM-5，参考标准）对患者进行评估。分析 3D-CAM 的灵敏度、特异性和阳性预测值（PPV）和阴性预测值（NPV），并进行测试-再测试和组内可靠性分析。
176 名患者中有 16 名（9.1%）发生 POD。3D-CAM 表现出很强的测试性能（特异性 0.88，敏感性 1.0，曲线下面积 0.94，PPV 0.44，NPV 1.0），测试-再测试可靠性为 90%（n=10），组内可靠性为 80%（n=10）。
在这项诊断研究中，3D-CAM 在恢复室中检测 POD 的性能较强。由于其培训要求低、应用速度快、灵敏度高，因此特别适合在评估 POD 方面经验有限的临床工作人员。
ClinicalTrials.gov 标识符：NCT02992717。
