Internal Medicine Service, The Prince Charles Hospital, Brisbane, QLD, Australia.
School of Medicine, Northside Clinical School, The Prince Charles Hospital, Brisbane, QLD, Australia.
Age Ageing. 2024 Jul 2;53(7). doi: 10.1093/ageing/afae144.
Delirium has conventionally been considered a disorder of consciousness. Alertness and arousal are used as surrogates in clinical practice but are insufficient for the purposes of a more dimensional assessment of consciousness. We present a process of development and validation of candidate measures of phenomenal consciousness that could be applied to the diagnosis of delirium.
First, a narrative review of available instruments in the fields of phenomenal consciousness, including prereflective consciousness, the phenomenal-sensed experience and reflective thought, was undertaken. Eligibility of tools in the context of applicability to delirium was based upon objectivity in test interpretation and the requirement for tester administration. Second, where there was a gap in suitable cognitive tools, new items were derived using the silent generation technique. A process of face and construct validity using a diverse panel of experts was performed, and readability was evaluated.
814 articles were screened from the literature review. Fourteen candidate tools were reported from the three domains of phenomenal consciousness. One of these met the eligibility criteria for a delirium assessment. Fifty-seven new tests of phenomenal consciousness were identified. After a process of item reduction, a total of 26 individual tests were identified. After content validity, 22 of the 26 items were retained. The scale average content validity index was 0.89. The agreement between raters was between 80% and 97%. 100% of responses for face validity were rated as positive. Flesch Reading Ease Score was 91.6 (very easy to read).
Candidate measures of phenomenal consciousness are described, and early validity studies are promising.
谵妄传统上被认为是一种意识障碍。警觉度和觉醒度被用作临床实践中的替代指标，但不足以对意识进行更具维度的评估。我们提出了一种发展和验证意识现象候选测量指标的过程，这些指标可用于谵妄的诊断。
首先，对意识现象领域的现有工具进行了叙述性综述，包括前反思意识、现象感知体验和反思性思维。根据测试解释的客观性和测试者管理的要求，评估工具在谵妄应用背景下的适用性。其次，在缺乏合适认知工具的情况下，使用静默生成技术衍生出新的项目。通过多元化的专家小组进行了表面效度和结构效度的评估，并对可读性进行了评估。
从文献综述中筛选出 814 篇文章。从意识现象的三个领域报告了 14 种候选工具。其中一种符合谵妄评估的资格标准。确定了 57 种新的意识现象测试。经过项目缩减过程，共确定了 26 个单独的测试。经过内容有效性评估，保留了 26 个项目中的 22 个。量表平均内容有效性指数为 0.89。评分者之间的一致性在 80%到 97%之间。对表面效度的 100%的反馈评价为正面。弗莱什阅读容易度得分 91.6（非常容易阅读）。
描述了意识现象的候选测量指标，早期有效性研究很有前景。
