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首页> 外文期刊>Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine >Screening, detection and management of delirium in the emergency department – a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED)
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Screening, detection and management of delirium in the emergency department – a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED)

机译：急诊室of妄的筛查，检测和管理–对老年急诊室患者使用新算法的可行性的初步研究：改进的急诊室混淆评估方法（mCAM-ED）

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Background Delirium in emergency department (ED) patients occurs frequently and often remains unrecognized. Most instruments for delirium detection are complex and therefore unfeasible for the ED. The aims of this pilot study were first, to confirm our hypothesis that there is an unmet need for formal delirium assessment by comparing informal delirium ratings of ED staff with formal delirium assessments performed by trained research assistants. Second, to test the feasibility of an algorithm for delirium screening, detection and management, which includes the newly developed modified Confusion Assessment Method for the Emergency Department (mCAM-ED) at the ED bedside. Third, to test interrater reliability of the mCAM-ED. Methods This was a pilot study with a pre-post-test design with two data collection periods before and after the implementation of the algorithm. Consecutive ED patients aged 65?years and older were screened and assessed in the ED of a tertiary care center by trained research assistants. The delirium detection rate of informal ratings by nurses and physicians was compared with the standardized mCAM-ED assessment performed by the research assistants. To show the feasibility at the ED bedside, defined as adherence of ED staff to the algorithm, only post-test data were used. Additionally, the ED nurses’ assessments were analyzed qualitatively. To investigate the agreement between research assistants and the reference standard, the two data sets were combined. Results In total, 207 patients were included in this study. We found that informal delirium assessment was inappropriate, even after a teaching intervention: Sensitivity of nurses to detect delirium without formal assessment was 0.27 pretest and 0.40 post-test, whilst sensitivity of physicians’ informal rating was 0.45 pre-test and 0.6 post-test. ED staff demonstrated high adherence to the algorithm (76.5%). Research assistants assessing delirium with the mCAM-ED demonstrated a high agreement compared to the reference standard (kappa?=?0.729). Conclusions Informal assessment of delirium is inadequate. The mCAM-ED proved to be useful at the ED bedside. Performance criteria need to be tested in further studies. The mCAM-ED may contribute to early identification of delirious ED patients.
机译：背景急诊科（ED）患者的Deli妄经常发生，并且经常未被发现。大多数del妄检测仪器很复杂，因此对于急诊室不可行。这项初步研究的目的首先是，通过比较急诊部工作人员的非正式del妄等级与训练有素的研究助手进行的正式del妄评估，来确认我们的假设，即正式formal妄评估的需求尚未得到满足。其次，测试del妄筛查，检测和管理算法的可行性，该算法包括新开发的经修改的急诊床旁急诊室混淆评估方法（mCAM-ED）。第三，测试mCAM-ED的界面可靠性。方法这是一项前瞻性研究，采用了前后测试设计，并在算法实施前后有两个数据收集期。由经过培训的研究助理在65岁及以上的连续ED患者中对三级护理中心的ED进行筛查和评估。将护士和医师对非正式评分的ir妄检出率与研究助手进行的标准化mCAM-ED评估进行比较。为了展示在ED床边（被定义为ED人员遵守算法）的可行性，仅使用了测试后数据。此外，对ED护士的评估进行了定性分析。为了研究研究助手与参考标准之间的一致性，将两个数据集进行了组合。结果本研究共纳入207例患者。我们发现，即使经过教学干预，非正式的ir妄评估也不恰当：护士未经正式评估而检测到ir妄的敏感性为测试前0.27和测试后0.40，而医生非正式评估的敏感性为测试前0.45和测试后0.6。 。 ED人员证明了对算法的高度遵守（76.5％）。与参考标准相比，使用mCAM-ED评估demonstrated妄的研究助手显示出很高的一致性（kappa = 0.729）。结论ir妄的非正式评估不充分。事实证明，mCAM-ED在ED床边非常有用。性能标准需要在进一步的研究中进行测试。 mCAM-ED可能有助于早期识别精神错乱的ED患者。

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