Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Int J Geriatr Psychiatry. 2022 Mar;37(3). doi: 10.1002/gps.5695.
Delirium is a common postoperative complication of hip fracture. Various methods exist to detect delirium as a reference standard. The goal of this study was to characterize the properties of the measures obtained in a randomized controlled trial, to document their relationship to the Diagnostic and Statistical Manual of Mental Disorders:Text Revision based diagnosis of postoperative delirium by a consensus panel, and to describe the method in detail to allow replication by others.
A secondary analysis of the randomized trial STRIDE (A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients) was conducted. Delirium assessments were performed in 200 consecutive hip fracture repair patients ≥65 years old. Assessors underwent extensive training in delirium assessment and the final delirium diagnosis was adjudicated by a consensus panel of three physicians with expertise in delirium assessment.
A total of 680 consensus panel delirium diagnoses were completed. There were only 19 (2.8%, 19/678) evaluations where the delirium adjudication by the consensus panel differed from delirium findings by the Confusion Assessment Method (CAM). In 16 (84%, 16/19) of the cases, CAM was negative but the consensus panel diagnosed the patient as having delirium based on all of the available information including the CAM.
The consensus panel diagnosis was more sensitive compared to CAM alone, however the magnitude of the difference was not large. When assessors are well trained and delirium assessments are closely supervised throughout the study, CAM may be adequate for delirium diagnosis in a clinical trial. Future studies are needed to test this hypothesis.
谵妄是髋部骨折术后常见的并发症。有多种方法可用于检测谵妄作为参考标准。本研究的目的是描述随机对照试验中获得的测量指标的特征，记录其与通过共识小组诊断术后谵妄的《精神障碍诊断与统计手册：文本修订版》之间的关系，并详细描述该方法，以便其他人能够复制。
对随机试验 STRIDE（减少老年患者术后谵妄发生率的策略）进行了二次分析。对 200 例连续接受髋部骨折修复手术且年龄≥65 岁的患者进行了谵妄评估。评估员接受了广泛的谵妄评估培训，最终的谵妄诊断由三位具有谵妄评估专业知识的医生组成的共识小组进行裁决。
共完成了 680 次共识小组的谵妄诊断。只有 19 次（2.8%，19/678）评估中，共识小组的谵妄裁决与混乱评估方法（CAM）的谵妄发现不同。在 16 例（84%，16/19）中，CAM 为阴性，但共识小组根据所有可用信息，包括 CAM，诊断患者患有谵妄。
与单独使用 CAM 相比，共识小组的诊断更敏感，但差异幅度不大。当评估员接受良好的培训且在整个研究过程中对谵妄评估进行密切监督时，CAM 可能足以用于临床试验中的谵妄诊断。需要进一步的研究来检验这一假设。
