Fliman Geriatric Hospital, Haifa, Israel.
Department of Medicine C, Bnai Zion Medical Center, 47 Golomb str, 3339419, Haifa, Israel.
BMC Geriatr. 2024 Mar 28;24(1):297. doi: 10.1186/s12877-024-04884-8.
Delirium is a frequent mental impairment in geriatric patients hospitalized in acute care facilities. It carries a high risk of complications and is often the first symptom of acute illness. It is clearly important to identify the development of delirium at an early stage, and several short and effective diagnostic tests have been developed and validated for this purpose. Despite this, patients on hospital wards are seldom monitored for signs of emergent delirium, suggesting that compliance with guidelines would be improved by introducing a simpler and more user-friendly test.
We recently implemented a simple delirium assessment tool, called RMA that can be introduced into the daily routine of ward staff without significantly adding to their workload. The nurses noted their impression of the patient's cognitive state in the electronic medical record, and during the morning round the ward physician administered a short attention test to any patients suspected of new cognitive impairment. In this study, we compared RMA test against the widely used and well validated 4AT.
RMA performed daily by the ward staff was found to be non-inferior to 4AT performed by an experienced rater. Compared to 4AT, R&M had a sensitivity of 93.9% and a specificity of 98.3%. An Altman-Bland plot indicated that both tests can be used interchangeably.
The RMA test is reliable, easy to administer, likely to boost compliance with guidelines, and is expected to raise awareness of delirium among the nurses and physicians directly involved in the diagnostic process.
谵妄是老年患者在急性护理机构住院时常见的精神障碍。它有很高的并发症风险，通常是急性疾病的首发症状。显然，早期识别谵妄的发生非常重要，为此已经开发并验证了几种简短有效的诊断测试。尽管如此，医院病房的患者很少监测是否出现紧急谵妄，这表明引入更简单、更易用的测试可以提高对指南的遵守程度。
我们最近实施了一种简单的谵妄评估工具，称为 RMA，它可以引入到病房工作人员的日常工作中，而不会显著增加他们的工作量。护士在电子病历中记录患者认知状态的印象，在早上查房时，病房医生对任何疑似新认知障碍的患者进行简短的注意力测试。在这项研究中，我们将 RMA 测试与广泛使用且经过充分验证的 4AT 进行了比较。
由病房工作人员每天进行的 RMA 测试被发现不劣于由经验丰富的评估者进行的 4AT。与 4AT 相比，RMA 的敏感性为 93.9%，特异性为 98.3%。一个 Altman-Bland 图表明，这两种测试可以互换使用。
RMA 测试可靠、易于管理，可能会提高对指南的遵守程度，并有望提高直接参与诊断过程的护士和医生对谵妄的认识。
