University of Rochester School of Medicine, Rochester, New York, USA.
Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2020 Nov;68(11):2572-2578. doi: 10.1111/jgs.16711. Epub 2020 Sep 15.
BACKGROUND/OBJECTIVES: Systematic screening can improve detection of delirium, but lack of time is often cited as why such screening is not performed. We investigated the time required to implement four screening protocols that use the Ultra-Brief two-item screener for delirium (UB-2) and the 3-Minute Diagnostic Interview for Confusion Assessment Method (CAM)-defined Delirium (3D-CAM), with and without a skip pattern that can further shorten the assessment. Our objective was to compare the sensitivity, specificity, and time required to complete four protocols: (1) full 3D-CAM on all patients, (2) 3D-CAM with skip on all patients, (3) UB-2, followed by the full 3D-CAM in "positives," and (4) UB-2, followed by the 3D-CAM with skip in "positives."
Comparative efficiency simulation study using secondary data.
Two studies (3D-CAM and Researching Efficient Approaches to Delirium Identification (READI)) conducted at a large academic medical center (3D-CAM and READI) and a small community hospital (READI only).
General medicine inpatients, aged 70 years and older (3D-CAM, n = 201; READI, n = 330).
We used 3D-CAM data to simulate the items administered under each protocol and READI data to calculate median administration time per item. We calculated sensitivity, specificity, and total administration time for each of the four protocols.
The 3D-CAM and READI samples had similar characteristics, and all four protocols had similar simulated sensitivity and specificity. Mean administration times were 3 minutes 13 seconds for 3D-CAM, 2 minutes 19 seconds for 3D-CAM with skip, 1 minute 52 seconds for UB-2 + 3D-CAM in positives, and 1 minute 14 seconds for UB-2 + 3D-CAM with skip in positives, which was 1 minute 59 seconds faster than the 3D-CAM (P < .001).
The UB-CAM, consisting of the UB-2, followed in positives by the 3D-CAM with skip pattern, is a time-efficient delirium screening protocol that holds promise for increasing systematic screening for delirium in hospitalized older adults.
背景/目的：系统筛查可以提高谵妄的检出率，但由于时间不足，通常无法进行此类筛查。我们研究了实施四种筛查方案所需的时间，这些方案使用超简短的谵妄二项筛查工具（UB-2）和三分钟诊断性访谈用于混乱评估方法（CAM）定义的谵妄（3D-CAM），以及是否使用可进一步缩短评估的跳过模式。我们的目的是比较四种方案的敏感性、特异性和所需时间：（1）对所有患者进行完整的 3D-CAM，（2）对所有患者进行 3D-CAM 跳过，（3）UB-2 后，对阳性患者进行完整的 3D-CAM，（4）UB-2 后，对阳性患者进行 3D-CAM 跳过。
使用二次数据进行比较效率模拟研究。
在一家大型学术医疗中心（3D-CAM 和 Researching Efficient Approaches to Delirium Identification（READI））和一家小型社区医院（仅 READI）进行的两项研究（3D-CAM 和 READI）。
年龄在 70 岁及以上的普通内科住院患者（3D-CAM，n=201；READI，n=330）。
我们使用 3D-CAM 数据模拟每种方案下进行的项目，并使用 READI 数据计算每个项目的中位数管理时间。我们计算了四种方案的敏感性、特异性和总管理时间。
3D-CAM 和 READI 样本具有相似的特征，所有四种方案的模拟敏感性和特异性相似。平均管理时间为 3 分钟 13 秒用于 3D-CAM，2 分钟 19 秒用于 3D-CAM 跳过，1 分钟 52 秒用于 UB-2+阳性患者的 3D-CAM，1 分钟 14 秒用于 UB-2+阳性患者的 3D-CAM 跳过，比 3D-CAM 快 1 分钟 59 秒（P<.001）。
由 UB-2 组成的 UB-CAM，在阳性患者中紧随其后的是带有跳过模式的 3D-CAM，是一种有效的谵妄筛查方案，有望增加对住院老年患者进行系统谵妄筛查。
