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Diagnostic accuracy of a rapid checklist to identify delirium in older patients transported by EMS

机译:快速清单的诊断准确性,以鉴定由EMS运送的老年患者的ir妄

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Background. The presence of delirium in elderly patients is common and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. Early recognition of delirium in the prehospital setting has the potential to improve outcomes, but is not feasible without valid assessment tools. Objective. To determine whether use of a rapid delirium checklist by prehospital providers is a valid way to identify cases of delirium compared with a criterion standard and whether the checklist is better at identifying delirium than the Glasgow Coma Score (GCS). Methods. We conducted a prospective study at two academic, tertiary-care emergency departments (EDs) where a convenience sample of matched dyads of emergency medical services providers and elderly patients (age ??65 years) were enrolled. Prehospital providers reported limited demographics and work history about themselves. They also reported vital signs and GCS for each patient and completed the checklist asking about presence of the four features of delirium. The patient then underwent a cognitive assessment using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by a trained investigator, which was used as the criterion standard. Criterion validity and concurrent validity of the delirium checklist and abnormal GCS were evaluated using sensitivity and specificity. Results. Two hundred fifty-nine matched dyads were studied. Delirium occurred in 24 (9%) of the elderly patients sampled. Prehospital providers' recognition of any delirium symptom resulted in a sensitivity of 0.63 (95% confidence interval [CI] 0.43-0.79) and a specificity of 0.74 (95% CI 0.73-0.84). Prehospital report of a GCS <15 has a sensitivity of 0.67 (95% CI 0.47-0.82) and a specificity of 0.85 (95% CI 0.80-0.89). Conclusions. A rapid delirium checklist can identify 63% of patients with delirium, but performed no better than the GCS. Future research should determine whether a rapid test of cognition improves early identification of elderly patients with delirium.
机译:背景。 elderly妄在老年患者中很常见,已被确定为增加死亡率和医院获得性并发症的独立标志,但医疗保健提供者对此知之甚少。在院前环境中尽早发现妄有可能改善结局,但如果没有有效的评估工具,这是不可行的。目的。为了确定院前服务人员使用快速del妄清单是否是识别a妄病例的有效方法,与标准标准相比,该清单是否比格拉斯哥昏迷评分(GCS)更好地识别del妄。方法。我们在两个学术性三级急诊科(ED)中进行了一项前瞻性研究,其中纳入了由急诊医疗服务提供者和老年患者(65岁)相匹配的二联体的便利样本。院前提供者报告了关于自己的人口统计和工作历史有限。他们还报告了每位患者的生命体征和GCS,并填写了清单,询问presence妄的四个特征是否存在。然后,由受过训练的研究者使用重症监护病房的混淆评估方法(CAM-ICU)对患者进行认知评估,该评估方法被用作标准标准。使用敏感性和特异性评估ir妄检查表和异常GCS的标准有效性和同时有效性。结果。研究了259个配对的二元组。抽取的24名老年患者中发生妄(9%)。院前提供者对任何del妄症状的识别导致敏感性为0.63(95%置信区间[CI] 0.43-0.79),特异性为0.74(95%CI 0.73-0.84)。医院前报告的GCS <15的敏感性为0.67(95%CI 0.47-0.82),特异性为0.85(95%CI 0.80-0.89)。结论。快速的ir妄检查清单可以识别63%的ir妄患者,但其表现并不比GCS好。未来的研究应该确定快速的认知测试是否可以改善老年ir妄患者的早期识别。

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