Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Emergency Services, Sunnybrook Research Institute, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2019 Nov;67(11):2370-2375. doi: 10.1111/jgs.16095. Epub 2019 Jul 29.
Recognition of delirium in the emergency department (ED) is poor. Our objectives were to assess: (1) the diagnostic accuracy of the Predicting Emergency department Delirium with an Interactive Computer Tablet (PrEDICT) "serious game" to identify older ED patients with delirium compared to clinical recognition and (2) the feasibility of the PrEDICT application compared to existing tests of attention.
Prospective observational study.
ED of a Canadian tertiary care center.
We included ED patients, aged 70 years and older, with a minimum 4-hour stay. We excluded anyone with critical illness, communication barriers, and visual impairment or those unable to use a computer tablet. None had prevalent delirium by ED clinicians' routine clinical assessment.
Participants were asked to tap targets on a tablet at four difficulty levels. Time and accuracy were automatically recorded. Other measures included the Confusion Assessment Method, the Delirium Severity Index, the Digit Vigilance Test (DVT), and the Choice Reaction Test (CRT).
We enrolled 203 patients. Their average age was 80.6 years, 49.8% were female, and their average ED length of stay was 15.9 hours. Sixteen subjects had clinically unrecognized delirium, and 14 of them completed the PrEDICT game (87.5%). We developed a threshold score with 100% sensitivity (95% confidence interval [CI] = 76.8%-100.0%) and 59.7% specificity (95% CI = 52.3%-66.6%) to identify patients with clinically unrecognized delirium. The area under the curve was 0.86 (95% CI = 0.77-0.94). Completion rates were 196/203 (96.6%) for the PrEDICT serious game compared to 128/203 (63.1%) for the CRT and 51/203 (25.1%) for the DVT.
Older ED patients were able to use our serious game, including 87.5% of those with clinically unrecognized delirium. The PrEDICT application has potential to act as a sensitive screening tool to identify older ED patients with clinically unrecognized delirium. J Am Geriatr Soc 67:2370-2375, 2019.
急诊科（ED）对谵妄的识别能力较差。我们的目的是评估：（1）与临床识别相比，使用预测 ED 谵妄的交互式计算机平板电脑（PrEDICT）“严肃游戏”来识别老年 ED 患者中存在谵妄的诊断准确性，以及（2）与现有注意力测试相比，PrEDICT 应用的可行性。
前瞻性观察性研究。
加拿大一家三级护理中心的 ED。
我们纳入了年龄在 70 岁及以上、在 ED 至少停留 4 小时的 ED 患者。排除任何患有重病、沟通障碍、视力障碍或无法使用计算机平板电脑的患者。没有患者存在 ED 临床医生常规临床评估的现有谵妄。
参与者被要求在四个难度级别上点击平板电脑上的目标。时间和准确性自动记录。其他措施包括意识错乱评估方法、谵妄严重程度指数、数字警戒测试（DVT）和选择反应测试（CRT）。
我们共纳入 203 名患者。他们的平均年龄为 80.6 岁，49.8%为女性，平均 ED 住院时间为 15.9 小时。16 名患者存在临床未识别的谵妄，其中 14 名完成了 PrEDICT 游戏（87.5%）。我们开发了一个阈值评分，具有 100%的敏感性（95%置信区间 [CI] = 76.8%-100.0%）和 59.7%的特异性（95% CI = 52.3%-66.6%），以识别临床未识别的谵妄患者。曲线下面积为 0.86（95% CI = 0.77-0.94）。与 CRT（128/203，63.1%）和 DVT（51/203，25.1%）相比，PrEDICT 严肃游戏的完成率为 203 名患者中的 196/203（96.6%）。
老年 ED 患者能够使用我们的严肃游戏，包括 87.5%的临床未识别的谵妄患者。PrEDICT 应用具有作为一种敏感的筛查工具的潜力，可以识别老年 ED 患者中临床未识别的谵妄。美国老年医学会 67:2370-2375，2019。
