Penfold Rose S, Squires Charlotte, Angus Alisa, Shenkin Susan D, Ibitoye Temi, Tieges Zoë, Neufeld Karin J, Avelino-Silva Thiago J, Davis Daniel, Anand Atul, Duckworth Andrew D, Guthrie Bruce, MacLullich Alasdair M J
Edinburgh Delirium Research Group, Ageing and Health and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.
NHS Lothian, Edinburgh, UK.
J Am Geriatr Soc. 2024 May;72(5):1508-1524. doi: 10.1111/jgs.18751. Epub 2024 Jan 19.
Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real-world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings.
PROSPERO (CRD42022385166). Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from 1980 to December 31, 2022. Included studies or audit reports used a validated delirium detection tool performed directly with the patient as part of routine care in large clinical populations (n ≥ 1000) within a general acute hospital setting. Narrative synthesis was performed.
Twenty-two research studies and four audit reports were included. Tools used alone or in combination were the Confusion Assessment Method (CAM), 4 'A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive Care Delirium Screening Checklist (ICDSC). Populations and settings varied and tools were used at different stages and frequencies in the patient journey, including on admission only; inpatient, daily or more frequently; on admission and as inpatient; inpatient post-operatively. Tool completion rates ranged from 19% to 100%. Admission positive score rates ranged from: CAM 8%-51%; 4AT 13%-20%. Inpatient positive score rates ranged from: CAM 2%-20%, DOSS 6%-42%, and NuDESC 5-13%. Postoperative positive score rates were 21% and 28% (4AT). All but two studies had moderate-high risk of bias.
This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in tool completion rates, and in delirium positive score rates relative to expected delirium prevalence. This study highlights a need for greater reporting and analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care.
多种简短的谵妄检测工具已在研究中得到验证并应用于日常护理，但在实际临床环境中对这些工具的研究较少。本系统评价综合了报告综合医院环境中大型临床人群谵妄检测工具完成率和/或谵妄阳性评分率的文献。
在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42022385166）中进行检索。检索了1980年至2022年12月31日期间的Medline、Embase、PsycINFO、CINAHL及灰色文献。纳入的研究或审计报告使用经过验证的谵妄检测工具，该工具作为综合急性医院环境中大型临床人群（n≥1000）日常护理的一部分直接应用于患者。进行叙述性综合分析。
纳入22项研究和4份审计报告。单独或联合使用的工具包括：谵妄评定法（CAM）、4A测试（4AT）、谵妄观察筛查量表（DOSS）、简易谵妄评定法（bCAM）、护理谵妄筛查量表（NuDESC）和重症监护谵妄筛查检查表（ICDSC）。研究人群和环境各不相同，这些工具在患者就医过程的不同阶段和频率使用，包括仅在入院时使用；住院期间，每日或更频繁使用；入院时及住院期间使用；术后住院期间使用。工具完成率在19%至100%之间。入院时的阳性评分率范围为：CAM 8% - 51%；4AT 13% - 20%。住院期间的阳性评分率范围为：CAM 2% - 20%，DOSS 6% - 42%，NuDESC 5% - 13%。术后阳性评分率分别为21%和28%（4AT）。除两项研究外，所有研究均存在中高偏倚风险。
本对大型急性患者人群中谵妄检测工具应用的系统评价发现，工具完成率以及谵妄阳性评分率相对于预期谵妄患病率存在临床上的显著差异。本研究强调需要更多地报告和分析相关医疗系统数据。这对于增进对日常护理中有效谵妄检测的理解至关重要。
