Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Northside Clinical School, School of Medicine, University of Queensland, Brisbane, Australia.
Age Ageing. 2021 Jun 28;50(4):1402-1405. doi: 10.1093/ageing/afaa269.
recognition of the multifactorial causes of delirium represents a clinical challenge.
to develop and show proof of principle of a diagnostic support tool (DST) for identification of causes of delirium.
stage 1-development of the aetiology in delirium-diagnostic support tool (AiD-DST); stage 2-validation of the AiD-DST against reference standard diagnosis, based on clinical assessment from two independent consultant geriatricians.
a series of eight steps AiD-DST were formulated by an expert group to identify possible causes of delirium. Forty inpatients admitted to a general medical unit with a consultant physician/geriatrician diagnosis of delirium were recruited, consented and reviewed against the AiD-DST. Mean age was 85.1 (standard deviation 7.9) years and 26 (65%) of participants were female. Participants had multiple chronic co-morbidities [median Charlson Comorbidity Index 7; interquartile range (IQR 6-9)] and median number of medications was 8 (IQR 6-11.75). Median number of causes of delirium detected on AiD-DST was 3 (IQR 3-4) versus 5 (IQR 3-6) using the reference standard diagnosis, with sensitivity of 88.8% (95% confidence interval, 81.6-93.9%) and specificity of 71.8% (63-79.5%).
the aetiology in delirium DST shows promise in the identification of cause(s) in delirium.
认识到谵妄的多因素病因是临床挑战。
开发并展示一种用于识别谵妄病因的诊断支持工具（DST）的原理验证。
第 1 阶段-谵妄病因诊断支持工具（AiD-DST）的开发；第 2 阶段-基于两位独立顾问老年病学家的临床评估，对 AiD-DST 进行参考标准诊断的验证。
专家组制定了一系列八项步骤的 AiD-DST，以确定谵妄的可能病因。共招募了 40 名因谵妄而被收入普通内科的住院患者，征得同意并根据 AiD-DST 进行了评估。参与者的平均年龄为 85.1 岁（标准差 7.9），26 名（65%）为女性。参与者患有多种慢性合并症[Charlson 合并症指数中位数为 7；四分位距（IQR 6-9）]，中位数服用药物数量为 8 种（IQR 6-11.75）。使用参考标准诊断，AiD-DST 检测到的谵妄病因中位数为 3 个（IQR 3-4），而参考标准诊断为 5 个（IQR 3-6），灵敏度为 88.8%（95%置信区间，81.6-93.9%），特异性为 71.8%（63-79.5%）。
谵妄病因 DST 在识别谵妄的病因方面显示出了潜力。
