心脏重症监护病房中婴儿谵妄筛查的观察者间信度：一项前瞻性观察研究。

Inter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study.

机构信息

Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University Health, Indianapolis, IN.

Division of Pediatric Critical Care, Logan Health Children's Hospital, Kalispell, MT.

出版信息

Pediatr Crit Care Med. 2023 Mar 1;24(3):e147-e155. doi: 10.1097/PCC.0000000000003182. Epub 2023 Jan 20.

DOI:10.1097/PCC.0000000000003182

PMID:36727939

Abstract

OBJECTIVES

To determine the inter-rater reliability (IRR) of the Cornell Assessment for Pediatric Delirium (CAP-D) in infants admitted to a cardiac ICU (CVICU) and to explore the impact of younger age and mechanical ventilation on IRR.

DESIGN

Prospective cross-sectional study of delirium screening performed by bedside CVICU nurses. We collected data from September 2020 to April 2021. We evaluated IRR with intraclass correlation coefficient (ICC) one-way random effects and Fleiss kappa for multiple raters.

SETTING

Eighteen-bed academic pediatric CVICU.

PARTICIPANTS

Subjects: Infants 1 day to 1 year old admitted to the CVICU, stratified in two age groups (≤ 9 wk and 9 wk to < 1 yr). Exclusion criteria were patients' immediate postoperative day, State Behavioral Scale score less than or equal to -2, or at risk for hemodynamic instability with assessment. Raters: CVICU nurses working in the unit during study days.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Groups of four raters performed 91 assessments, a total of 364 CAP-D screens. Forty-five of 91 (49%) were in patients less than or equal to 9 weeks old and 43 of 91 (47%) in mechanically ventilated patients. Sixty-eight of 81 nurses (81%) participated. In infants less than or equal to 9 weeks old, ICC was 0.59 (95% CI 0.44-0.71), poor to moderate reliability, significantly lower than the ICC in infants greater than 9 weeks and 0.72 (95% CI 0.61-0.82), moderate to good reliability. In mechanically ventilated infants, ICC was 0.5 (95% CI 0.34-0.65), poor to moderate reliability, significantly lower than the ICC in nonmechanically ventilated infants and 0.69 (95% CI 0.57-0.8), moderate to good reliability. Fleiss kappa for all infants was 0.47 (95% CI 0.34-0.6), slight to fair agreement. Use of anchor points did not improve reliability.

CONCLUSIONS

In the youngest, most vulnerable infants admitted to the CVICU, further evaluation of the CAP-D tool is needed.

摘要

目的

确定在心脏重症监护病房（CVICU）收治的婴儿中使用 Cornell 儿科谵妄评估量表（CAP-D）的组内一致性（IRR），并探讨年龄较小和机械通气对 IRR 的影响。

设计

对 CVICU 床边护士进行的谵妄筛查进行前瞻性横断面研究。我们收集了 2020 年 9 月至 2021 年 4 月的数据。我们使用组内相关系数（ICC）单向随机效应和 Fleiss kappa 评估多个评估者的 IRR。

地点

18 床学术儿科 CVICU。

参与者

对象：年龄在 1 天至 1 岁之间，入住 CVICU 的婴儿，分为两个年龄组（≤9 周和 9 周至<1 岁）。排除标准为患者术后即刻、状态行为量表评分等于或小于-2 分，或因评估而有血流动力学不稳定的风险。评估者：研究日在 CVICU 工作的护士。

干预措施

无。

测量和主要结果

4 名评估者进行了 91 次评估，共进行了 364 次 CAP-D 筛查。91 次评估中，45 次在≤9 周龄的患者中进行，43 次在机械通气患者中进行。81 名护士中的 68 名（81%）参与了研究。在≤9 周龄的婴儿中，ICC 为 0.59（95%CI 0.44-0.71），可靠性差到中等，明显低于>9 周龄婴儿的 ICC，为 0.72（95%CI 0.61-0.82），可靠性为中等至良好。在机械通气的婴儿中，ICC 为 0.5（95%CI 0.34-0.65），可靠性差到中等，明显低于非机械通气婴儿的 ICC，为 0.69（95%CI 0.57-0.8），可靠性为中等至良好。所有婴儿的 Fleiss kappa 为 0.47（95%CI 0.34-0.6），为轻度至中度一致性。使用锚定点并不能提高可靠性。