The Gerontologist · 2012
Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population: the GEM study.
СтатьяНаблюдательное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Powers James S, Doering Tracey, Gordon Sharon, Eden Svetlana K, Shintani Ayumi, Schnelle John
Аннотация
OBJECTIVE: To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit.
DESIGN: Prospective observational cohort study.
SETTING: Postacute geriatric hospital ward of a Veteran's Affairs hospital.
PARTICIPANTS: Consecutively admitted patients between 50 and 100 years old for inpatient postacute medical care.
MEASUREMENTS: Two teams, blinded to one another's evaluations, performed daily delirium assessments using either the Confusion Assessment Method for the intensive care unit (CAM-ICU) or clinical assessment based on DSM-IV.
RESULTS: There were 61 patients enrolled (median 73 years old, range: 52-94), who underwent 521 paired observations. Delirium was detected in 18 patients (29.5%) by one of the two screening methods over the course of the study, most of whom (14 patients, 23%) were delirious on the first day of enrollment. Delirium was identified by the CAM-ICU on 12.6% of the observations and by the clinical assessment on 6% of the observations (κ = 0.25, 95% confidence interval [CI]: 0.09, 0.40). Examination of disagreement between the 2 evaluations revealed that patients with dementia (κ = 0.11, 95% CI: -0.14, 0.27) had 10.7 times higher odds (95% CI: [3.1, 36.8], p value < .001) of having discordance than patients without dementia.
CONCLUSIONS: Different delirium assessments may disagree depending on the study population. Dementia patients are especially challenging to evaluate for delirium.
DESIGN: Prospective observational cohort study.
SETTING: Postacute geriatric hospital ward of a Veteran's Affairs hospital.
PARTICIPANTS: Consecutively admitted patients between 50 and 100 years old for inpatient postacute medical care.
MEASUREMENTS: Two teams, blinded to one another's evaluations, performed daily delirium assessments using either the Confusion Assessment Method for the intensive care unit (CAM-ICU) or clinical assessment based on DSM-IV.
RESULTS: There were 61 patients enrolled (median 73 years old, range: 52-94), who underwent 521 paired observations. Delirium was detected in 18 patients (29.5%) by one of the two screening methods over the course of the study, most of whom (14 patients, 23%) were delirious on the first day of enrollment. Delirium was identified by the CAM-ICU on 12.6% of the observations and by the clinical assessment on 6% of the observations (κ = 0.25, 95% confidence interval [CI]: 0.09, 0.40). Examination of disagreement between the 2 evaluations revealed that patients with dementia (κ = 0.11, 95% CI: -0.14, 0.27) had 10.7 times higher odds (95% CI: [3.1, 36.8], p value < .001) of having discordance than patients without dementia.
CONCLUSIONS: Different delirium assessments may disagree depending on the study population. Dementia patients are especially challenging to evaluate for delirium.