修订版谵妄评定量表（DRS-R98）在重症监护环境中用于谵妄严重程度评估的有效性和适用性。
The Validity and Applicability of the Revised Delirium Rating Scale (DRS-R98) for Delirium Severity Assessment in a Critical Care Setting.
作者信息
Almuhairi Eiman Saeed, Badejo Monica, Peer Aneesa, Pitkanen Mervi, McKenzie Cathrine A
机构信息
Institute of Pharmaceutical Sciences, School of Cancer and Pharmacy, King's College, London, UK.
Department of Social, Therapeutic and Community Studies, Goldsmiths College, University of London, London, UK.
出版信息
J Intensive Care Med. 2024 Mar;39(3):240-249. doi: 10.1177/08850666231199986. Epub 2023 Sep 5.
BACKGROUND
Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness.
METHODS
This prospective, cohort study was conducted in adults with delirium admitted to a critical care unit and predicted to stay for ≥ 24 h. We excluded patients with severe neurological or communication barriers that would have interfered with the DRS-R98 assessment. Patients were screened using a delirium detection algorithm and the Confusion Assessment Method for the Intensive Care Unit. Eligible patient informations were collected and reported to qualified assessor/s before visiting clinical areas, confirming delirium presence and undertaking DRS- R98 assessments. To assess the tool's construct validity, an intensivist completed the Clinical Global Impression-Scale (CGI-S). To calculate the inter-rater reliability (IRR) a subset of patients were simultaneously evaluated by two assessors.
RESULTS
We assessed 22 patients, 73% were male, with a median age of 65 years (IQR14). The DRS -R98 mean (SD) severity score was 24 (+/-7.7), total scale was 29 (+/18.0), and CGI-S 3.5 (+/11.5). Assessment duration was 90 min (+/-55) and 15 min (+/-5) for record data extraction and clinical assessment respectively. The CGI-S significantly correlated with DRS-R98 severity (r = 0.626) and total (r = 0.628) scales. The DRS-R98 Cronbach's alpha was 0.896 for severity scale and 0.886 for total scale. The inter-rater reliability (IRR) was assessed in six patients and reported an inter-correlation coefficient of 0.505 (p = 0.124) and 0.565 (p = 0.93) for the severity and total scale respectively.
CONCLUSIONS
In critical care, the Delirium Rating Scale R98 had good construct validity, excellent internal consistency, and moderate inter-rater reliability.
背景
谵妄是危重症中常见的一种神经精神综合征。谵妄严重程度的恶化与较差的临床结局相关，但其评估报告仍不充分，大多数严重程度评估工具尚未在重症监护中得到验证。DRS-R98是一种广泛应用且经过验证的工具。本项目的目的是报告DRS-R98在危重症中的验证情况及实用性。
方法
本前瞻性队列研究纳入了入住重症监护病房且预计住院时间≥24小时的成年谵妄患者。我们排除了存在严重神经或沟通障碍而可能干扰DRS-R98评估的患者。使用谵妄检测算法和重症监护病房意识模糊评估方法对患者进行筛查。在进入临床区域之前，收集符合条件的患者信息并报告给合格的评估人员，确认谵妄的存在并进行DRS-R98评估。为评估该工具的结构效度，一名重症医学专家完成了临床总体印象量表（CGI-S）。为计算评分者间信度（IRR），由两名评估人员同时对一部分患者进行评估。
结果
我们评估了22例患者，其中73%为男性，中位年龄为65岁（四分位间距14）。DRS-R98的平均（标准差）严重程度评分为24（±7.7），总分29（±18.0），CGI-S为3.5（±1.5）。记录数据提取的评估时间为90分钟（±55），临床评估为15分钟（±5）。CGI-S与DRS-R98严重程度（r = 0.626）和总分（r = 0.628）量表显著相关。DRS-R98严重程度量表的Cronbach's α系数为0.896，总量表为0.886。对6例患者进行了评分者间信度（IRR）评估，严重程度量表和总量表的组内相关系数分别为0.505（p = 0.124）和0.565（p = 0.93）。
结论
在重症监护中，谵妄评定量表R98具有良好的结构效度、出色的内部一致性和中等的评分者间信度。
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