Harvard Medical School, Boston, Massachusetts, USA,
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA,
Dement Geriatr Cogn Disord. 2020;49(1):77-90. doi: 10.1159/000506700. Epub 2020 Jun 17.
Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies.
We aimed to report our development of new delirium severity items and the results of item reduction and selection activities guided by psychometric analysis of data derived from a field study.
Building on our literature review of delirium instruments and expert panel process to identify domains of delirium severity, we adapted items from existing delirium severity instruments and generated new items. We then fielded these items among a sample of 352 older hospitalized patients.
We used an expert panel process and psychometric data analysis techniques to narrow a set of 303 potential items to 17 items for use in a new delirium severity instrument. The 17-item set demonstrated good internal validity and favorable psychometric characteristics relative to comparator instruments, including the Confusion Assessment Method - Severity (CAM-S) score, the Delirium Rating Scale Revised 98, and the Memorial Delirium Assessment Scale.
We more fully conceptualized delirium severity and identified characteristics of an ideal delirium severity instrument. These characteristics include an instrument that is relatively quick to administer, is easy to use by raters with minimal training, and provides a severity rating with good content validity, high internal consistency reliability, and broad domain coverage across delirium symptoms. We anticipate these characteristics to be represented in the subsequent development of our final delirium severity instrument.
谵妄是一种常见且可预防的老年综合征。超越谵妄存在/不存在的二元分类，谵妄严重程度代表了评估预防和治疗干预措施以及跟踪患者病程的一个潜在重要结果。尽管目前存在几种谵妄严重程度评估工具，但大多数都是在缺乏先进测量方法的情况下开发的，并且没有经过严格的验证研究评估。
我们旨在报告我们开发新的谵妄严重程度项目的情况，并报告根据来自现场研究的数据的心理测量分析进行项目删减和选择活动的结果。
基于我们对谵妄工具的文献回顾和专家小组流程，以确定谵妄严重程度的领域，我们从现有的谵妄严重程度工具中改编了项目，并生成了新的项目。然后，我们在 352 名住院老年患者样本中进行了这些项目的测试。
我们使用专家小组流程和心理测量数据分析技术，将一组 303 个潜在项目缩小到 17 个项目，用于新的谵妄严重程度工具。该 17 项集合表现出良好的内部有效性和相对于比较工具的有利心理测量特征，包括意识混乱评估方法-严重程度（CAM-S）评分、修订后的 98 项谵妄评定量表和纪念谵妄评定量表。
我们更全面地概念化了谵妄严重程度，并确定了理想的谵妄严重程度工具的特征。这些特征包括一个相对快速的评估工具，易于经过最少培训的评估者使用，并且提供具有良好内容效度、高内部一致性可靠性和广泛的谵妄症状领域覆盖范围的严重程度评分。我们预计这些特征将在我们最终的谵妄严重程度工具的后续开发中得到体现。
