Sederstrom Jane R, Aliory Christine D, Hanneman Elaine M, Buras Matthew R
Jane R. Sederstrom, MSN, APRN, AGCNS-BC, CCRN, Clinical Nurse Specialist, Department of Nursing, Mayo Clinic Arizona, Phoenix, AZ.
Christine D. Aliory, MSN, APRN, AGCNS-BC, ONC, CURN, Clinical Nurse Specialist, Department of Nursing, Mayo Clinic Arizona, Phoenix, AZ.
Orthop Nurs. 2021;40(1):16-22. doi: 10.1097/NOR.0000000000000726.
Delirium in the hospitalized orthopaedic patient is associated with numerous negative outcomes. Assessing for the presence of delirium using an accurate and reliable tool is essential. However, the number of validated screening tools is limited. The purpose of this study was to validate and test the reliability of the Delirium Triage Screening and brief Confusion Assessment Method (DTS/bCAM) to screen for delirium in non-intensive care (ICU) orthopaedic and hematological patients. This was a prospective, observational study. Seventy-six delirium assessments were completed on 19 orthopaedic patients and 10 hematological patients. The clinical nurse performed the DTS/bCAM during every 12-hour shift. Within 2 hours of this assessment, a research investigator performed both the DTS/bCAM and the Confusion Assessment Method (CAM). Each patient had a maximum of three assessments by a research investigator. Interrater reliability for the clinical nurse and the researcher was measured through comparison of positive and negative DTS/bCAM results. Validity was measured by comparing the matched DTS/bCAM and CAM results, both performed by the researcher. The DTS/bCAM and CAM results had 100% agreement. Two patients (7%) screened positive for delirium. Sensitivity of the DTS/bCAM was 100% (95% CI [15.8-100]) and specificity was 100% (95% CI [95.1, 100]). There was 86% agreement (43/50) between the clinical nurse and the researcher for the DTS/bCAM. In adult orthopaedic and hematological patients not receiving intensive care, the DTS/bCAM may be a valid, reliable, and rapid screening tool for delirium.
住院骨科患者的谵妄与众多不良后果相关。使用准确可靠的工具评估谵妄的存在至关重要。然而，经过验证的筛查工具数量有限。本研究的目的是验证和测试谵妄分诊筛查与简易意识模糊评估方法（DTS/bCAM）在非重症监护病房（ICU）骨科和血液科患者中筛查谵妄的可靠性。这是一项前瞻性观察性研究。对19名骨科患者和10名血液科患者完成了76次谵妄评估。临床护士在每12小时轮班期间进行DTS/bCAM评估。在此次评估的2小时内，研究人员同时进行DTS/bCAM和意识模糊评估方法（CAM）。每位患者最多接受研究人员的三次评估。通过比较DTS/bCAM的阳性和阴性结果来测量临床护士和研究人员之间的评分者间信度。效度通过比较研究人员执行的匹配DTS/bCAM和CAM结果来测量。DTS/bCAM和CAM结果的一致性为100%。两名患者（7%）谵妄筛查呈阳性。DTS/bCAM的敏感性为100%（95%CI[15.8 - 100]），特异性为100%（95%CI[95.1, 100]）。临床护士和研究人员对DTS/bCAM的一致性为86%（43/50）。在未接受重症监护的成年骨科和血液科患者中，DTS/bCAM可能是一种有效、可靠且快速的谵妄筛查工具。
