重症监护病房患者的谵妄筛查：护士研究人员和 bedside 护士在常规实践中对 iCAM-ICU 的前瞻性验证研究。

Delirium screening for patients in the intensive care unit: A prospective validation study of the iCAM-ICU by nurse researchers and bedside nurses in routine practice.

机构信息

School of Nursing, Capital Medical University, 10 YouAnmenWai Xitoutiao, Fengtai District, Beijing, China.

School of Nursing, Capital Medical University, 10 YouAnmenWai Xitoutiao, Fengtai District, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.

出版信息

Int J Nurs Stud. 2021 May;117:103886. doi: 10.1016/j.ijnurstu.2021.103886. Epub 2021 Jan 26.

DOI:10.1016/j.ijnurstu.2021.103886

PMID:33631399

Abstract

BACKGROUND

Daily delirium assessment using the Confusion Assessment Method for the Intensive Care Unit was recommended for patients in the intensive care unit, yet implementation may be difficult because of lack of simple and standardized data collection schemes which may result in low sensitivities when used by bedside nurses.

OBJECTIVE

This study was to validate the diagnostic accuracy of the intelligent Confusion Assessment Method for the Intensive Care Unit (iCAM-ICU) used by both nurse investigators and bedside nurses in Chinese patients in the intensive care unit.

DESIGN

Prospective cohort study.

SETTING

A university affiliated tertiary hospital in China.

PARTICIPANTS

A total of 373 hospitalized patients (181 in phase I and 192 in phase II) in the intensive care units met the inclusion criteria and participated in the study. There were two nursing researchers (phase I) and 24 bedside nurses (phase II) used the iCAM-ICU to assess delirium among patients.

METHODS

Two prospective cohort studies were conducted to validate the diagnostic accuracy of iCAM-ICU on delirium screening when it was used by nurse investigators and bedside nurses in the intensive care unit. Using the Diagnostic and Statistical Manual of Mental Disorders as the gold standard, the sensitivity, specificity, predictive values along with the likelihood ratios were determined to estimate the performance of the iCAM-ICU in patients in the intensive care setting. The Kappa consistency test was examined to determine the inter-rater consistency. Subgroup analysis in terms of different age, level of education, severity of illness and cognitive status were also conducted to evaluate potential variations of the iCAM-ICU performance in different patient groups.

RESULTS

A total of 373 patients were included in the validation studies. In comparing with the gold standard, the sensitivities of the iCAM-ICU demonstrated by the two nurse investigators were 95.2 % and 93.7%, while the specificities of the iCAM-ICU were 93.3% and 93.2%. The Kappa consistency between two nurse investigators was 0.96. The sensitivity and specificity of the iCAM-ICU demonstrated by bedside nurses in intensive care patients were 86.7% and 97.7%, respectively. Subgroup analysis also revealed that the sensitivities and specificities in those different subgroups were acceptable, with all statistics being above 80%.

CONCLUSIONS

The iCAM-ICU, an information technology enabled delirium screening tool, showed highly acceptable accuracy in detecting delirium in the intensive care units. It can assist bedside nurses to detect delirium reliably and identify potential patients with delirium accurately.

REGISTRATION NUMBER

ChiCTR-OCH-13003050.

摘要

背景

每日使用 ICU 意识模糊评估法对 ICU 患者进行谵妄评估被推荐，但是由于缺乏简单和标准化的数据收集方案，可能导致床边护士使用时的敏感性较低，因此实施可能具有挑战性。

目的

本研究旨在验证智能 ICU 意识模糊评估法（iCAM-ICU）在 ICU 中国患者中由护士研究者和床边护士使用的诊断准确性。

设计

前瞻性队列研究。

地点

中国一所大学附属医院。

参与者

共有 373 名住院患者（第 I 阶段 181 名，第 II 阶段 192 名）符合纳入标准并参与了研究。有两名护理研究人员（第 I 阶段）和 24 名床边护士（第 II 阶段）使用 iCAM-ICU 评估患者的谵妄。

方法

进行了两项前瞻性队列研究，以验证当护士研究者和 ICU 床边护士使用 iCAM-ICU 进行谵妄筛查时，其对谵妄筛查的诊断准确性。以《精神障碍诊断与统计手册》为金标准，确定敏感性、特异性、预测值以及似然比，以评估 iCAM-ICU 在 ICU 环境中患者中的性能。通过 Kappa 一致性检验来检验评分者间的一致性。还进行了基于不同年龄、教育程度、疾病严重程度和认知状态的亚组分析，以评估 iCAM-ICU 在不同患者群体中的性能的潜在变化。

结果

共有 373 名患者纳入验证研究。与金标准相比，两名护士研究者使用 iCAM-ICU 显示的敏感性分别为 95.2%和 93.7%，而特异性分别为 93.3%和 93.2%。两名护士研究者之间的 Kappa 一致性为 0.96。在 ICU 患者中，床边护士使用 iCAM-ICU 的敏感性和特异性分别为 86.7%和 97.7%。亚组分析还表明，在这些不同亚组中，敏感性和特异性均可以接受，所有统计数据均高于 80%。