这个病人有 Delirium 吗? : 床边仪器的价值
Camilla L Wong1, Jayna Holroyd-Leduc, David L Simel
1Division of Geriatrics, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. camilla.wong@utoronto.ca
JAMA
|August 19, 2010
概括
混评估方法 (CAM) 是诊断住院成年人的妄想症的最准确的床边仪器,提供快速管理的可靠识别. 这一系统性审查突出了其在其他选工具上的卓越性能.
科学领域:
- 老年学是指老年学的学科.
- 神经科学是一个神经科学.
- 临床医学 临床医学
背景情况:
- 狂妄症是住院老年人的常见和严重的疾病,通常导致死亡率和长期护理安置等不良结果.
- 尽管 Delirium 的流行程度和后果很大,但医疗保健专业人员往往对其缺乏认可.
- 需要简单,准确的床边诊断仪器来改善妄想的识别.
研究的目的:
- 系统地审查用于识别成人住院患者痴呆症的各种床边仪器的诊断准确性.
- 在临床环境中比较不同 Delirium 选工具在临床环境中的有效性.
主要方法:
- 在MEDLINE和EMBASE数据库中进行了全面的文献搜索,并补充了参考列表的审查.
- 包括的研究是前性诊断准确性调查,比较床边妄想仪器与黄金标准诊断.
- 黄金标准诊断是由老年医生,精神科医生或神经病学家使用DSM-IV标准来确定的.
主要成果:
- 分析了25项涉及3027名患者和11种不同的仪器的研究.
- 一些仪器,包括混评估方法 (CAM),显示高准确度 (正概率比>5.0) 检测妄想.
- 该CAM显示了最好的整体性能,总结-正的概率比为9.6和总结-负的概率比为0.16,表明强大的诊断效用.
结论:
- 混评估方法 (CAM) 是最有证据支持的诊断痴呆症的床边工具.
- 该CAM是高效的,只需要5分钟的管理,使其适用于繁忙的临床环境.
- 仪器的选择可能取决于可用的时间和检查员的纪律,但CAM提供了最强大的数据来准确检测妄想.
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