Siriraj Palliative Care Center, Mahidol University, Bangkok, Thailand.
Department Psychiatry, Mahidol University, Bangkok, Thailand.
Oncologist. 2020 Feb;25(2):e335-e340. doi: 10.1634/theoncologist.2019-0399. Epub 2019 Nov 7.
Delirium, a neuropsychiatric syndrome that occurs throughout medical illness trajectories, is frequently misdiagnosed. The Memorial Delirium Assessment Scale (MDAS) is a commonly used tool in palliative care (PC) settings. Our objective was to establish and validate the Memorial Delirium Assessment Scale-Thai version (MDAS-T) in PC patients.
The MDAS was translated into Thai. Content validity, inter-rater reliability, and internal consistency were explored. The construct validity of the MDAS-T was analyzed using exploratory factor analysis. Instrument testing of the MDAS-T, the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU-T), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition as the gold standard was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff score. The duration of each assessment was recorded.
The study enrolled 194 patients. The content validity index was 0.97. The intraclass correlation coefficient and Cronbach's α coefficient were 0.98 and 0.96, respectively. A principal component analysis indicated a homogeneous, one-factor structure. The area under the ROC curve was 0.96 (95% confidence interval [CI], 0.93-0.99). The best combination of sensitivity and specificity (95% CI) of the MDAS-T were 0.92 (0.85-0.96) and 0.90 (0.82-0.94), respectively, with a cutoff score of 9, whereas the CAM-ICU-T yielded 0.58 (0.48-0.67) and 0.98 (0.93-0.99), respectively. The median MDAS-T assessment time was 5 minutes.
This study established and validated the MDAS-T as a good and feasible tool for delirium screening and severity rating in PC settings.
Delirium is prevalent in palliative care (PC) settings and causes distress to patients and families, thereby making delirium screening necessary. This study found that the MDAS-T is a highly objective and feasible test for delirium screening and severity monitoring in PC settings and can greatly improve the quality of care for this population.
谵妄是一种在整个疾病过程中发生的神经精神综合征，经常被误诊。《纪念谵妄评估量表》（MDAS）是姑息治疗（PC）环境中常用的工具。我们的目的是建立和验证 MDAS-泰文版（MDAS-T）在 PC 患者中的适用性。
MDAS 被翻译成泰文。内容效度、评定者间信度和内部一致性进行了探讨。使用探索性因子分析对 MDAS-T 的结构效度进行了分析。使用 MDAS-T、泰国版重症监护病房意识模糊评估方法（CAM-ICU-T）和《精神障碍诊断与统计手册》第五版作为金标准对 MDAS-T 进行了仪器测试。接收者操作特征（ROC）曲线用于确定最佳截断分数。记录了每次评估的持续时间。
研究纳入了 194 名患者。内容效度指数为 0.97。组内相关系数和克朗巴赫's α系数分别为 0.98 和 0.96。主成分分析表明具有同质的单因素结构。ROC 曲线下面积为 0.96（95%置信区间[CI]，0.93-0.99）。MDAS-T 的最佳灵敏度和特异性（95%CI）组合分别为 0.92（0.85-0.96）和 0.90（0.82-0.94），截断值为 9，而 CAM-ICU-T 分别为 0.58（0.48-0.67）和 0.98（0.93-0.99）。MDAS-T 的中位评估时间为 5 分钟。
本研究建立并验证了 MDAS-T 作为一种在姑息治疗环境中用于谵妄筛查和严重程度评分的良好且可行的工具。
谵妄在姑息治疗（PC）环境中很常见，会给患者和家属带来痛苦，因此有必要进行谵妄筛查。本研究发现，MDAS-T 是一种用于 PC 环境中谵妄筛查和严重程度监测的高度客观和可行的测试，可以大大提高该人群的护理质量。
