School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
Ageing Res Rev. 2023 Sep;90:102025. doi: 10.1016/j.arr.2023.102025. Epub 2023 Jul 30.
Delirium is a common neuropsychiatric syndrome that is often overlooked in clinical settings. The most accurate instrument for screening delirium has not been established. This study aimed to compare the diagnostic accuracy of the 4 'A's Test (4AT), Nursing Delirium Screening Scale (Nu-DESC), and Confusion Assessment Method (CAM) in detecting delirium among older adults in clinical settings. These assessment tools feature concise item sets and straightforward administration procedures. Five electronic databases were systematically searched from their inception to September 7, 2022. Studies evaluating the sensitivity and specificity of the 4AT, Nu-DESC, and CAM against the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases as the reference standard were included. Bivariate random effects model was used to summarize the sensitivity and specificity results. A total of 38 studies involving 7378 patients were included. The 4AT, Nu-DESC, and CAM had comparable sensitivity in detecting delirium (0.76, 0.78, and 0.80, respectively). However, the specificity of the CAM was higher than that of the 4AT (0.98 vs 0.89, P = .01) and Nu-DESC 0.99 vs 0.90, P = .003). Diagnostic accuracy was moderated by the percentage of women, acute care setting, sample size, and assessors. The three tools exhibit comparable sensitivity, and the CAM has the highest specificity. Based on the feasibility of the tools, nurses and clinical staffs could employ the Nu-DESC and the 4AT on screening out positive delirium cases and integrate these tools into daily practice. Further investigations are warranted to verify our findings.
谵妄是一种常见的神经精神综合征，在临床环境中经常被忽视。目前尚未确定用于筛查谵妄的最准确仪器。本研究旨在比较 4' A' s 测试（4AT）、护理谵妄筛查量表（Nu-DESC）和意识混乱评估方法（CAM）在检测临床环境中老年人谵妄的诊断准确性。这些评估工具具有简洁的项目集和简单的管理程序。从成立到 2022 年 9 月 7 日，系统地对五个电子数据库进行了搜索。包括评估 4AT、Nu-DESC 和 CAM 对精神障碍诊断和统计手册或国际疾病分类标准作为参考标准的敏感性和特异性的研究。使用双变量随机效应模型总结敏感性和特异性结果。共有 38 项研究涉及 7378 名患者。4AT、Nu-DESC 和 CAM 在检测谵妄方面具有相当的敏感性（分别为 0.76、0.78 和 0.80）。然而，CAM 的特异性高于 4AT（0.98 与 0.89，P = 0.01）和 Nu-DESC（0.99 与 0.90，P = 0.003）。诊断准确性受到女性百分比、急性护理环境、样本量和评估者的调节。这三种工具的敏感性相当，CAM 的特异性最高。基于工具的可行性，护士和临床工作人员可以使用 Nu-DESC 和 4AT 筛查出阳性谵妄病例，并将这些工具整合到日常实践中。需要进一步的研究来验证我们的发现。
