Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (E.R.M.).
Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania (D.M.F.).
Ann Intern Med. 2022 Jan;175(1):65-73. doi: 10.7326/M21-1687. Epub 2021 Nov 9.
Systematic screening improves delirium identification among hospitalized older adults. Little data exist on how to implement such screening.
To test implementation of a brief app-directed protocol for delirium identification by physicians, nurses, and certified nursing assistants (CNAs) in real-world practice relative to a research reference standard delirium assessment (RSDA).
Prospective cohort study.
Large urban academic medical center and small rural community hospital.
527 general medicine inpatients (mean age, 80 years; 35% with preexisting dementia) and 399 clinicians (53 hospitalists, 236 nurses, and 110 CNAs).
On 2 study days, enrolled patients had an RSDA. Subsequently, CNAs performed an ultra-brief 2-item screen (UB-2) for delirium, whereas physicians and nurses performed a 2-step protocol consisting of the UB-2 followed in those with a positive screen result by the 3-Minute Diagnostic Assessment for the Confusion Assessment Method.
Delirium was diagnosed in 154 of 924 RSDAs (17%) and in 114 of 527 patients (22%). The completion rate for clinician protocols exceeded 97%. The CNAs administered the UB-2 in a mean of 62 seconds (SD, 51). The 2-step protocols were administered in means of 104 seconds (SD, 99) by nurses and 106 seconds (SD, 105) by physicians. The UB-2 had sensitivities of 88% (95% CI, 72% to 96%), 87% (CI, 73% to 95%), and 82% (CI, 65% to 91%) when administered by CNAs, nurses, and physicians, respectively, with specificities of 64% to 70%. The 2-step protocol had overall accuracy of 89% (CI, 83% to 93%) and 87% (CI, 81% to 91%), with sensitivities of 65% (CI, 48% to 79%) and 63% (CI, 46% to 77%) and specificities of 93% (CI, 88% to 96%) and 91% (CI, 86% to 95%), for nurses and physicians, respectively. Two-step protocol sensitivity for moderate to severe delirium was 78% (CI, 54% to 91%).
Two sites; limited diversity.
An app-directed protocol for delirium identification was feasible, brief, and accurate, and CNAs and nurses performed as well as hospitalists.
National Institute on Aging.
系统筛查可提高住院老年患者的谵妄识别率。关于如何实施这种筛查，数据很少。
测试医生、护士和注册护士助理（CNA）使用应用程序指导的简单方案进行谵妄识别的实施情况，相对于研究参考标准评估（RSDA）。
前瞻性队列研究。
大型城市学术医疗中心和小型农村社区医院。
527 名普通医学住院患者（平均年龄 80 岁；35%有预先存在的痴呆症）和 399 名临床医生（53 名医院医生、236 名护士和 110 名 CNA）。
在 2 个研究日，纳入的患者接受 RSDA。随后，CNA 进行了超简短的 2 项筛查（UB-2）以评估谵妄，而医生和护士则进行了两步方案，包括 UB-2，如果筛查结果为阳性，则使用 3 分钟诊断评估方法对意识混乱评估方法进行进一步评估。
在 924 次 RSDA 中有 154 次（17%）和 527 例患者中的 114 次（22%）诊断为谵妄。临床医生方案的完成率超过 97%。CNA 平均在 62 秒内（SD，51 秒）完成 UB-2。护士和医生分别在 104 秒（SD，99 秒）和 106 秒（SD，105 秒）完成两步方案。当由 CNA、护士和医生实施时，UB-2 的敏感性分别为 88%（95%CI，72%至 96%）、87%（CI，73%至 95%）和 82%（CI，65%至 91%），特异性为 64%至 70%。两步方案的总准确率为 89%（CI，83%至 93%）和 87%（CI，81%至 91%），护士和医生的敏感性分别为 65%（CI，48%至 79%）和 63%（CI，46%至 77%），特异性分别为 93%（CI，88%至 96%）和 91%（CI，86%至 95%）。两步方案中，中度至重度谵妄的敏感性为 78%（CI，54%至 91%）。
两个地点；多样性有限。
用于识别谵妄的应用程序指导方案可行、简洁且准确，CNA 和护士与医院医生的表现一样好。
美国国家老龄化研究所。
