Raman Rameela, DesAutels Spencer J, Lauck Alana M, Scher Alexa M, Walden Rachel L, Kiehl Amy L, Collar Erin M, Ely E Wesley, Pandharipande Pratik P, Jackson James C
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN.
Crit Care Explor. 2022 Dec 22;4(12):e0830. doi: 10.1097/CCE.0000000000000830. eCollection 2022 Dec.
To conduct a systematic review to summarize cognitive instruments being used in long-term outcome studies of survivors of adult critical illness, as well as evaluate whether these measures are reported as using patient demographic norms, specifically race norms.
A comprehensive search was conducted in PubMed (National Center for Biotechnology Information), Excerpta Medica dataBASE (Ovid), Psychological Information Database (ProQuest), and Web of Science (Clarivate) for English language studies published since 2002.
Studies were eligible if the population included adult ICU survivors assessed for postdischarge cognitive outcomes.
Two independent reviewers screened abstracts, examined full text, and extracted data from all eligible articles.
A total of 98 articles (55 unique cohorts: 22 general ICU, 14 Acute respiratory distress syndrome/Acute respiratory failure/Sepsis, 19 COVID-19 and other subpopulations) were eligible for data extraction and synthesis. Among general ICU survivors, the majority of studies ( = 15, 68%) assessed cognition using multiple instruments, of which the most common was the Mini-Mental State Examination. Only nine of the 22 studies (41%) explicitly reported using patient demographic norms for scoring neuropsychological cognitive tests. Of the nine, all reported using age as a norming characteristic, education was reported in eight (89%), sex/gender was reported in five (55%), and race/ethnicity was reported in three (33%). Among Acute respiratory distress syndrome/Acute respiratory failure/Sepsis survivors, norming characteristics were reported in only four (28%) of the 14 studies, of which all reported using age and none reported using race/ethnicity.
Less than half of the studies measuring cognitive outcomes in ICU survivors reported the use of norming characteristics. There is substantial heterogeneity in how studies reported the use of cognitive instruments, and hence, the prevalence of the use of patient norms may be underestimated. These findings are important in the development of appropriate standards for use and reporting of neuropsychological tests among ICU survivors.
进行一项系统综述，以总结成人危重症幸存者长期结局研究中使用的认知工具，并评估这些测量方法是否报告使用了患者人口统计学标准，特别是种族标准。
对美国国立医学图书馆的医学期刊数据库（PubMed）、医学文摘数据库（Excerpta Medica dataBASE，Ovid）、心理学信息数据库（Psychological Information Database，ProQuest）和科睿唯安的科学引文索引数据库（Web of Science，Clarivate）进行全面检索，以查找自2002年以来发表的英文研究。
如果研究人群包括评估出院后认知结局的成人重症监护病房（ICU）幸存者，则该研究符合条件。
两名独立评审员筛选摘要、审查全文，并从所有符合条件的文章中提取数据。
共有98篇文章（55个独立队列：22个普通ICU队列、14个急性呼吸窘迫综合征/急性呼吸衰竭/脓毒症队列、19个新型冠状病毒肺炎及其他亚组队列）符合数据提取和综合的条件。在普通ICU幸存者中，大多数研究（n = 15，68%）使用多种工具评估认知，其中最常用的是简易精神状态检查表。在22项研究中，只有9项（41%）明确报告在对神经心理学认知测试进行评分时使用了患者人口统计学标准。在这9项研究中，所有研究都报告使用年龄作为标准化特征，8项（89%）报告使用教育程度，5项（55%）报告使用性别，3项（33%）报告使用种族/民族。在急性呼吸窘迫综合征/急性呼吸衰竭/脓毒症幸存者中，14项研究中只有4项（28%）报告了标准化特征，其中所有研究都报告使用年龄，没有研究报告使用种族/民族。
在测量ICU幸存者认知结局的研究中，不到一半的研究报告使用了标准化特征。研究报告认知工具使用情况的方式存在很大异质性，因此，患者标准的使用流行率可能被低估。这些发现对于制定ICU幸存者神经心理学测试的适当使用和报告标准很重要。
