使用 eDIS-ICU 对重症监护病房的谵妄进行筛查——一款专门设计的应用：一项初步研究。

Screening for delirium in the intensive care unit using eDIS-ICU - A purpose-designed app: A pilot study.

机构信息

Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Clinical Sciences Building, Rode Road, Chermside 4032, Brisbane, Australia; Northside Medical School, University of Queensland, The Prince Charles Hospital, Rode Road, Chermside 4032, Brisbane, Australia.

Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Clinical Sciences Building, Rode Road, Chermside 4032, Brisbane, Australia; Department of Mental Health, Royal Brisbane and Women's Hospital, Herston Road, Herston QLD 4029, Australia; Queensland University of Technology, Kelvin Grove Road, Kelvin Grove QLD 4059, Brisbane, Australia.

出版信息

Aust Crit Care. 2021 Nov;34(6):547-551. doi: 10.1016/j.aucc.2020.12.008. Epub 2021 Mar 22.

DOI:10.1016/j.aucc.2020.12.008

PMID:33766486

Abstract

INTRODUCTION

Delirium, a common complication of an intensive care unit (ICU) admission, is inconsistently diagnosed by clinicians. Current screening tools require specialist expertise and/or training. Some are time-consuming to administer, and reliability in routine clinical practice is questionable. An innovative app designed to enable efficient and sensitive screening for delirium without specialist training (eDIS-ICU) has recently been described. This pilot study compared the eDIS-ICU against the reference standard expert assessment using DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria and the Confusion Assessment Method for the ICU (CAM-ICU).

METHODS

In this prospective, single-centre pilot study, a convenience sample of 29 ICU patients were recruited at a tertiary referral hospital between November 2018 and August 2019. After obtaining written consent, demographic and clinical data were collected, and the patients were screened for delirium using eDIS-ICU and CAM-ICU by two clinician researchers in random order. The patients were also assessed for presence of delirium independently by an expert clinician using a structured interview to diagnose as per DSM-V criteria. The results of screening and diagnosis were tabulated to allow comparison of screening tools against diagnosis; sensitivity and specificity of the tools were calculated.

RESULTS

Seven participants were diagnosed with delirium as per DSM-V criteria. The eDIS-ICU tool correctly identified six of these participants compared with two identified by CAM-ICU. The sensitivity of the eDIS-ICU tool was 86% (95% confidence interval [CI] = 81.5-100.0) compared with 29% (95% CI = 5.1-69.7) for CAM-ICU (p < 0.05), and the specificity was 73% (95% CI = 81.5-100.0) versus 96% (95% CI = 75.1-99.8), respectively.

CONCLUSION

The simple and novel eDIS-ICU delirium screening tool was noninferior to the CAM-ICU in detecting delirium as per DSM-V criteria. A definitive validation study is warranted.

摘要

简介

谵妄是重症监护病房（ICU）入院的常见并发症，但临床医生对其诊断不一致。目前的筛查工具需要专业知识和/或培训。有些工具耗时较长，在常规临床实践中的可靠性也值得怀疑。最近，有人描述了一种创新的应用程序，可以在没有专业培训的情况下，高效、敏感地筛查谵妄，该应用程序称为电子谵妄筛查工具（eDIS-ICU）。本研究旨在比较 eDIS-ICU 与使用 DSM-V（精神障碍诊断与统计手册，第五版）标准和 ICU 意识模糊评估法（CAM-ICU）的专家评估作为参考标准的准确性。

方法

这是一项前瞻性、单中心的试点研究，于 2018 年 11 月至 2019 年 8 月在一家三级转诊医院对 29 名 ICU 患者进行了便利抽样。在获得书面同意后，收集人口统计学和临床数据，并由两名临床研究人员以随机顺序使用 eDIS-ICU 和 CAM-ICU 对患者进行谵妄筛查。然后，由一名专家临床医生使用结构化访谈对患者进行独立评估，以根据 DSM-V 标准诊断是否存在谵妄。对筛查和诊断的结果进行制表，以比较筛查工具与诊断的一致性；计算工具的敏感性和特异性。

结果

根据 DSM-V 标准，有 7 名参与者被诊断为谵妄。eDIS-ICU 工具正确识别了其中 6 名参与者，而 CAM-ICU 只识别了 2 名。eDIS-ICU 工具的敏感性为 86%（95%置信区间[CI]为 81.5-100.0），CAM-ICU 为 29%（95% CI 为 5.1-69.7）（p<0.05），特异性分别为 73%（95% CI 为 81.5-100.0）和 96%（95% CI 为 75.1-99.8）。