Hur Hyun Jung, Jang Yu Na, Park Hye Yoon, Lee Young Seok, Ro Du Hyun, Kang Beodeul, Song Kyoung-Ho, Park Hye Youn
Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea.
Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Front Psychiatry. 2022 Aug 18;13:976228. doi: 10.3389/fpsyt.2022.976228. eCollection 2022.
Delirium is a neuropsychiatric condition strongly associated with poor clinical outcomes such as high mortality and long hospitalization. In the patients with Coronavirus disease 2019 (COVID-19), delirium is common and it is considered as one of the risk factors for mortality. For those admitted to negative-pressure isolation units, a reliable, validated and contact-free delirium screening tool is required.
We prospectively recruited eligible patients from multiple medical centers in South Korea. Delirium was evaluated using the Confusion Assessment Method (CAM) and 4'A's Test (4AT). The attentional component of the 4AT was modified such that respondents are required to count days, rather than months, backward in Korean. Blinded medical staff evaluated all patients and determined whether their symptoms met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). An independent population of COVID-19 patients was used to validate the 4AT as a remote delirium screening tool. We calculated the area under the receiver operating characteristic curve (AUC).
Out of 286 general inpatients, 28 (9.8%) inpatients had delirium. In this population, the patients with delirium were significantly older ( = 0.018) than the patients without delirium, and higher proportion of males were included in the delirium group ( < 0.001). The AUC of the 4AT was 0.992 [95% confidence interval (CI) 0.983-1.000] and the optimal cutoff was at 3. Of the independent COVID-19 patients, 13 of 108 (12.0%) had delirium. Demographically, the COVID-19 patients who had delirium only differed in employment status ( = 0.047) from the COVID-19 patients who did not have delirium. The AUC for remote screening using the 4AT was 0.996 (0.989-1.000). The optimal cutoff of this population was also at 3.
The modified K-4AT had acceptable reliability and validity when used to screen inpatients for delirium. More importantly, the 4AT efficiently screened for delirium during remote evaluations of COVID-19 patients, and the optimal cutoff was 3. The protocol presented herein can be used for remote screening of delirium using the 4AT.
谵妄是一种神经精神疾病，与高死亡率和长期住院等不良临床结局密切相关。在2019冠状病毒病（COVID-19）患者中，谵妄很常见，被认为是死亡风险因素之一。对于入住负压隔离病房的患者，需要一种可靠、经过验证且无需接触的谵妄筛查工具。
我们在韩国多个医疗中心前瞻性招募符合条件的患者。使用混乱评估法（CAM）和4'A'测试（4AT）评估谵妄。对4AT的注意力部分进行了修改，要求受访者用韩语倒着数天数，而不是月份。不知情的医务人员对所有患者进行评估，并确定其症状是否符合《精神疾病诊断与统计手册》第5版（DSM-5）的谵妄标准。使用一组独立的COVID-19患者群体来验证4AT作为远程谵妄筛查工具的有效性。我们计算了受试者工作特征曲线（AUC）下的面积。
在286名普通住院患者中，28名（9.8%）住院患者患有谵妄。在该人群中，患有谵妄的患者比未患谵妄的患者年龄显著更大（P = 0.018），谵妄组中男性比例更高（P < 0.001）。4AT的AUC为0.992 [95%置信区间（CI）0.983 - 1.000]，最佳截断值为3。在独立的COVID-19患者中，108名中有13名（12.0%）患有谵妄。在人口统计学方面，患有谵妄的COVID-19患者与未患谵妄的COVID-19患者仅在就业状况上存在差异（P = 0.047）。使用4AT进行远程筛查的AUC为0.996（0.989 - 1.000）。该人群的最佳截断值也为3。
改良的韩语版4AT在用于筛查住院患者谵妄时具有可接受的可靠性和有效性。更重要的是，4AT在对COVID-19患者进行远程评估时能有效筛查谵妄，最佳截断值为3。本文介绍的方案可用于使用4AT进行谵妄的远程筛查。
