谵妄访谈作为评估工具研究中的新参考标准。

The Delirium Interview as a new reference standard in studies on delirium assessment tools.

机构信息

Department of Intensive Care Medicine and UMC Utrecht Brain Center, University Medical Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

Department of Psychiatry and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

出版信息

J Am Geriatr Soc. 2023 Jun;71(6):1923-1930. doi: 10.1111/jgs.18263. Epub 2023 Feb 21.

DOI:10.1111/jgs.18263

Abstract

BACKGROUND

The reference standard in studies on delirium assessment tools is usually based on the clinical judgment of only one delirium expert and may be concise, unstandardized, or not specified at all. This multicenter study investigated the performance of the Delirium Interview, a new reference standard for studies on delirium assessment tools allowing classification of delirium based on written reports.

METHODS

We tested the diagnostic accuracy of our standardized Delirium Interview by comparing delirium assessments of the reported results with live assessments. Our reference, the live assessment, was performed by two delirium experts and one well-trained researcher who registered the results. Their delirium assessment was compared to the majority vote of three other independent delirium experts who judged the rapportage of the Delirium Interview. Our total pool consisted of 13 delirium experts with an average of 13 ± 8 years of experience.

RESULTS

We included 98 patients (62% male, mean age 69 ± 12 years), of whom 56 (57%) intensive care units (ICUs) patients, 22 (39%) patients with a Richmond Agitation Sedation Scale (RASS) < 0 and 26 (27%) non-verbal assessments. The overall prevalence of delirium was 28%. The Delirium Interview had a sensitivity of 89% (95% confidence interval [CI]: 71%-98%) and specificity of 82% (95% CI: 71%-90%), compared to the diagnosis of an independent panel of two delirium experts and one researcher who examined the patients themselves. Negative and positive predictive values were 95% (95% CI: 86%-0.99%), respectively, 66% (95% CI: 49%-80%). Stratification into ICU and non-ICU patients yielded similar results.

CONCLUSION

The Delirium Interview is a feasible reference method for large study cohorts evaluating delirium assessment tools since experts could assess delirium with high accuracy without seeing the patient at the bedside.

摘要

背景

研究中评估谵妄的参考标准通常基于一位谵妄专家的临床判断，且可能简明扼要、不规范或根本未作具体说明。本多中心研究使用新的谵妄评估参考标准——即《谵妄访谈》，对其评估诊断准确性进行了研究，该标准可基于书面报告对谵妄进行分类。

方法

我们通过比较报告结果的《谵妄访谈》评估与现场评估，来测试标准化《谵妄访谈》的诊断准确性。我们的现场评估由两位谵妄专家和一位经过良好培训的研究人员进行，他们记录了评估结果。现场评估与三位其他独立谵妄专家的多数意见进行了比较，后者对《谵妄访谈》的报告进行了判断。我们的专家库共包含 13 位专家，平均从业经验为 13±8 年。

结果

共纳入 98 例患者（62%为男性，平均年龄 69±12 岁），其中 56 例（57%）为重症监护病房（ICU）患者，22 例（39%）为 Richmond 躁动镇静量表（RASS）评分<0 的患者，26 例（27%）为非言语评估患者。谵妄总体患病率为 28%。与由两位独立的谵妄专家和一位亲自检查患者的研究人员组成的独立专家组的诊断相比，《谵妄访谈》的敏感性为 89%（95%置信区间[CI]：71%-98%），特异性为 82%（95% CI：71%-90%）。阴性和阳性预测值分别为 95%（95% CI：86%-0.99%）和 66%（95% CI：49%-80%）。对 ICU 与非 ICU 患者进行分层后，结果类似。