背景:急性卒中患者特别容易发生谵妄。虽然谵妄检测很重要,迄今为止,尚未就如何对这些患者进行谵妄常规筛查,或在这一人群中使用哪种工具进行筛查,提出以证据为基础的建议.因此,这项研究的目的是确定急性卒中患者的谵妄筛查工具,并总结其准确性。
方法:遵循系统评价和荟萃分析指南的首选报告项目,系统搜索Medline,CINAHL和Scopus数据库包括:(a)诊断测试准确性研究;(b)评估急性中风患者谵妄的评估工具;(c)以英文撰写;(d)截至2018年9月发表。通过使用诊断准确性研究的质量评估-2来评估所包括的研究的质量。
结果:迄今为止,该领域共进行了四项研究,其所用方法和主要两种工具的准确性记录质量各不相同,如(1)谵妄(4AT)的4-评估测试,报告敏感性为90.2%~100%,特异性为64.5%~86%;(2)混淆评估方法-重症监护病房(CAM-ICU)的敏感性为76%(95%置信区间[CI]55-91),特异性为98%(95CI93-100).其他工具已被研究为:缩写的心理测验-10,缩写的心理测验简短形式,时钟绘制测试,认知检查来源于美国国立卫生研究院卒中量表和格拉斯哥昏迷量表。此外,使用单个问题-即,正如多学科团队所回答的那样,“该患者是否有认知问题?”已经接受了验证过程。
结论:迄今为止,已经发表了一些主要研究来测试工具在检测卒中后谵妄能力方面的准确性;在现有的研究中,对4AT和CAM-ICU工具进行了大量研究。研究刚刚开始为在卒中患者中检测和有效评估新获得性谵妄的挑战增加证据:因此,需要更多的研究来提高知识,并允许在该人群中选择最有用的工具。
BACKGROUND: Patients with acute stroke are particularly vulnerable to delirium episodes. Although delirium detection is important, no evidence-based recommendations have been established to date on how these patients should be routinely screened for delirium or which tool should be used for this purpose in this population. Therefore, the aim of this study was to identify delirium screening tools for patients with acute stroke and to summarise their accuracy.
METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of Medline, CINAHL and Scopus databases was performed to include: (a) diagnostic test accuracy studies; (b) evaluating tools detecting delirium among patients with acute stroke; (c) written in English; (d) published up to September 2018. The included studies were assessed in their quality by using the Quality Assessment of Diagnostic Accuracy Studies-2.
RESULTS: A total of four studies have been performed to date in the field with a variable quality for the methodology used and documentation of the accuracy of mainly two tools, as (1) the 4-Assessment Test for delirium (4AT), reporting a range of sensitivity from 90.2 to 100% and a specificity from 64.5 to 86%; and (2) the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) showing a sensitivity of 76% (95% Confidence of Interval [CI] 55-91) and a specificity of 98% (95%CI 93-100). Other tools have been studied as: The Abbreviated Mental Test-10, the Abbreviated Mental Test short form, the Clock Drawing Test, the Cognitive Examination derived from the National Institutes of Health Stroke Scale and the Glasgow Coma Scale. Moreover, the use of a single question-namely, \'Does this patient have cognitive issues?\' as answered by the multidisciplinary team-has been subjected to a validation process.
CONCLUSIONS: To date a few primary studies have been published to test the accuracy of tools in their ability to detect post-stroke delirium; among those available, the 4AT and the CAM-ICU tools have been mostly studied. Research has just started to add evidence to the challenge of detecting and usefully assessing newly-acquired delirium among stroke patients: therefore, more studies are needed to improve the knowledge and allow a robust selection of the most useful tool to use in this population.