Pompei P, Foreman M, Cassel C K, Alessi C, Cox D
University of Chicago, Ill.
Arch Intern Med. 1995 Feb 13;155(3):301-7.
Delirium occurs commonly among older hospitalized patients and is frequently not recognized. In an effort to identify tools useful to clinicians in the diagnosis of delirium, test characteristics of four screening instruments were compared.
Patients 65 years of age or older who were admitted to one of four medical and surgical wards of a university teaching hospital were followed up prospectively. Potential subjects were excluded if unavailable for interviews or discharged within 48 hours of admission, or if judged too impaired to participate in the daily interviews. Research assistants administered four instruments used to detect delirium: Digit Span Test, Vigilance 'A' Test, Clinical Assessment of Confusion, and Confusion Assessment Method. Abnormal scores on these tests or suspicion of acute confusion prompted a referral to the clinician-investigators who then assessed the patient daily for delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria.
Delirium occurred in 64 (14.8%) of 432 subjects. The positive likelihood ratios for all of the instruments were significantly more than 1. The instruments remained useful when applied to selected subgroups: subjects in whom acute mental status changes were documented, subjects on surgical services, and subjects with impaired cognitive status on admission. Combinations of any two instruments did not perform substantially better than the instrument with the best test characteristics: the Clinical Assessment of Confusion. All instruments were more useful at confirming delirium than in excluding it.
The four instruments studied, which are suitable for use at the bedside, can aid the clinician in identifying patients likely to be suffering from delirium.
谵妄在老年住院患者中很常见，且常常未被识别。为了确定对临床医生诊断谵妄有用的工具，对四种筛查工具的测试特征进行了比较。
对入住一所大学教学医院四个内科和外科病房之一的65岁及以上患者进行前瞻性随访。如果潜在受试者无法接受访谈、入院后48小时内出院，或被判定身体过于虚弱无法参与日常访谈，则将其排除。研究助理使用四种用于检测谵妄的工具：数字广度测试、警觉性“A”测试、混乱临床评估和混乱评估方法。这些测试的异常分数或对急性精神错乱的怀疑促使转诊给临床研究人员，然后他们根据《精神疾病诊断与统计手册》第三版修订标准每天对患者进行谵妄评估。
432名受试者中有64名（14.8%）发生谵妄。所有工具的阳性似然比均显著大于1。当应用于选定的亚组时，这些工具仍然有用：记录有急性精神状态变化的受试者、外科手术患者以及入院时认知状态受损的受试者。任意两种工具的组合在表现上并不比测试特征最佳的工具（混乱临床评估）好很多。所有工具在确诊谵妄方面比排除谵妄更有用。
所研究的这四种工具适用于床边使用，可帮助临床医生识别可能患有谵妄的患者。
