背景

ICU患者建议使用ICU谵妄评估方法进行每日评估，但是由于缺乏简单而标准化的数据收集方案，因此可能难以实施，从而导致床边护士使用时敏感性较低。

目的

本研究在中国的ICU患者中，验证由研究护士和床旁护士在日常工作中进行的iCAM-ICU诊断谵妄的准确率。

设计

前瞻性队列研究。

场所

中国的一家大学附属三级医院。

参加者

ICU病房共有373名住院患者（I期181名，II期192名）符合纳入研究。有两名护理研究人员（第一阶段）和24名床边护士（第二阶段）使用iCAM-ICU评估患者谵妄。

方法

进行了两项前瞻性队列研究，以验证iCAM-ICU在重症监护病房的护士调查员和床边护士使用时，对谵妄筛查的诊断准确性。使用《精神疾病诊断和统计手册》作为黄金标准，确定敏感性，特异性，预测值以及似然比，以评估重症监护患者中iCAM-ICU的表现。检查Kappa一致性测试以确定评估者之间的一致性。还对不同年龄，受教育程度，疾病严重程度和认知状态进行了亚组分析，以评估不同患者组中iCAM-ICU表现的潜在差异。

结果

总共373名患者纳入验证研究。与金标准相比，两名研究护士证明的iCAM-ICU的敏感性分别为95.2％和93.7％，而iCAM-ICU的特异性分别为93.3％和93.2％。两名研究护士之间的Kappa一致性为0.96。床边护士对重症监护患者显示iCAM-ICU的敏感性和特异性分别为86.7％和97.7％。亚组分析显示，不同亚组的敏感性和特异性可以接受，所有统计数据均高于80％。

结论

iCAM-ICU是一种启用了信息技术的谵妄筛查工具，在重症监护室中识别谵妄的检测显示出高度可接受的准确性。它可以帮助床边护士可靠地检测出谵妄，并准确地识别潜在的谵妄患者。

 

 

Abstract

Background

Daily delirium assessment using the Confusion Assessment Method for the Intensive Care Unit was recommended for patients in the intensive care unit, yet implementation may be difficult because of lack of simple and standardized data collection schemes which may result in low sensitivities when used by bedside nurses.

Objective

This study was to validate the diagnostic accuracy of the intelligent Confusion Assessment Method for the Intensive Care Unit (iCAM-ICU) used by both nurse investigators and bedside nurses in Chinese patients in the intensive care unit.

Design

Prospective cohort study.

Setting

A university affiliated tertiary hospital in China.

Participants

A total of 373 hospitalized patients (181 in phase I and 192 in phase II) in the intensive care units met the inclusion criteria and participated in the study. There were two nursing researchers (phase I) and 24 bedside nurses (phase II) used the iCAM-ICU to assess delirium among patients.

Methods

Two prospective cohort studies were conducted to validate the diagnostic accuracy of iCAM-ICU on delirium screening when it was used by nurse investigators and bedside nurses in the intensive care unit. Using the Diagnostic and Statistical Manual of Mental Disorders as the gold standard, the sensitivity, specificity, predictive values along with the likelihood ratios were determined to estimate the performance of the iCAM-ICU in patients in the intensive care setting. The Kappa consistency test was examined to determine the inter-rater consistency. Subgroup analysis in terms of different age, level of education, severity of illness and cognitive status were also conducted to evaluate potential variations of the iCAM-ICU performance in different patient groups.

Results

A total of 373 patients were included in the validation studies. In comparing with the gold standard, the sensitivities of the iCAM-ICU demonstrated by the two nurse investigators were 95.2 % and 93.7%, while the specificities of the iCAM-ICU were 93.3% and 93.2%. The Kappa consistency between two nurse investigators was 0.96. The sensitivity and specificity of the iCAM-ICU demonstrated by bedside nurses in intensive care patients were 86.7% and 97.7%, respectively. Subgroup analysis also revealed that the sensitivities and specificities in those different subgroups were acceptable, with all statistics being above 80%.

Conclusions

The iCAM-ICU, an information technology enabled delirium screening tool, showed highly acceptable accuracy in detecting delirium in the intensive care units. It can assist bedside nurses to detect delirium reliably and identify potential patients with delirium accurately.

Registration number

ChiCTR-OCH-13003050.

原文链接：

https://www.sciencedirect.com/science/article/pii/S0020748921000183

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