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首页> 外文期刊>The journal of clinical psychiatry >An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method.
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An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method.

机译：使用Delphi方法进行的抗精神病药物恶性综合症诊断标准的国际共识研究。

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OBJECTIVE: The lack of generally accepted diagnostic criteria for neuroleptic malignant syndrome (NMS) impedes research and clinical management of patients receiving antipsychotic medications. The purpose of this study was to develop NMS diagnostic criteria reflecting a broad consensus among clinical knowledge experts, represented by an international multispecialty physician panel. PARTICIPANTS: Eleven psychiatrists, 2 neurologists, 2 anesthesiologists, and 2 emergency medicine specialists participated in a formal Delphi consensus procedure. EVIDENCE: A core bibliography consisting of 12 prominent, current reviews of the NMS literature was identified by an objective, comprehensive electronic search strategy. Each panel member was given a copy of these references and asked to examine them before commencing the survey process. CONSENSUS PROCESS: After reviewing the core bibliography, panel members were asked to list any clinical signs or symptoms or diagnostic studies that they believed, on the basis of their knowledge and clinical experience, were useful in making a diagnosis of NMS. In subsequent survey rounds, panel members assigned priority points to these items, and items that failed to receive a minimum priority score were eliminated from the next round. Information about individual panel member responses was fed back to the group anonymously in the form of the group median or mean and the number of members who had ranked or scored each survey item. The a priori consensus endpoint was defined operationally as a change of 10% or less in the mean priority score for any individual item, and an average absolute value change of 5% or less across all items, between consecutive rounds. The survey was conducted from January 2009 through September 2009. RESULTS: Consensus was reached on the fifth round regarding the following criteria: recent dopamine antagonist exposure, or dopamine agonist withdrawal; hyperthermia; rigidity; mental status alteration; creatine kinase elevation; sympathetic nervous system lability; tachycardia plus tachypnea; and a negative work-up for other causes. The panel also reached a consensus on the relative importance of these criteria and on the following critical values for quantitative criteria: hyperthermia, > 100.4 degrees F or > 38.0 degrees C on at least 2 occasions; creatine kinase elevation, at least 4 times the upper limit of normal; blood pressure elevation, >/= 25% above baseline; blood pressure fluctuation, >/= 20 mm Hg (diastolic) or >/= 25 mm Hg (systolic) change within 24 hours; tachycardia, >/= 25% above baseline; and tachypnea, >/= 50% above baseline. CONCLUSIONS: These diagnostic criteria significantly advance the field because they represent the consensus of an international multispecialty expert panel, include critical values, provide guidance regarding the relative importance of individual elements, and are less influenced by particular theoretical biases than most previously published criteria. They require validation before being applied in clinical settings.
机译：目的：缺乏抗精神病药物恶性综合症（NMS）的公认诊断标准，阻碍了接受抗精神病药物治疗的患者的研究和临床管理。这项研究的目的是制定NMS诊断标准，以反映由国际多专科医生小组代表的临床知识专家之间的广泛共识。参与者：11名精神科医生，2名神经科医生，2名麻醉师和2名急诊医学专家参加了正式的Delphi共识程序。证据：通过客观，全面的电子搜索策略，确定了一个核心书目，该书目由NMS文献的12条当前最新评论组成。为每个小组成员提供了这些参考文献的副本，并要求他们在开始调查过程之前对其进行检查。共识过程：在审查核心书目后，要求小组成员列出他们认为基于其知识和临床经验对诊断NMS有用的任何临床体征或症状或诊断研究。在随后的调查回合中，小组成员为这些项目分配了优先级，未获得最低优先级得分的项目则从下一轮中剔除。有关小组成员个人回答的信息以小组中位数或均值以及对每个调查项目进行排名或评分的成员数量的形式匿名反馈给小组。先验共识终点在操作上被定义为任何单个项目的平均优先级分数变化在10％或以下，而在连续两轮之间所有项目的平均绝对值变化在5％以下。该调查于2009年1月至2009年9月进行。结果：第五轮就以下标准达成了共识：最近的多巴胺拮抗剂暴露或多巴胺激动剂退出;热疗;刚性;精神状态改变;肌酸激酶升高;交感神经系统不稳定心动过速加呼吸急促;以及其他原因造成的负面影响。专家组还就这些标准的相对重要性以及定量标准的以下临界值达成了共识：至少2次出现体温过高，> 100.4华氏度或> 38.0摄氏度;肌酸激酶升高，至少是正常上限的4倍;血压升高，比基线高出> / = 25％;血压波动在24小时内变化> / = 20 mm Hg（舒张压）或> / = 25 mm Hg（收缩压）;心动过速，比基线高> / = 25％;和呼吸急促，高于基线> / = 50％。结论：这些诊断标准代表了国际多学科专家小组的共识，具有临界值，可为各个要素的相对重要性提供指导，并且不受大多数​​先前公布的标准的特定理论偏见的影响，因此可大大推动该领域的发展。他们需要验证才能应用于临床环境。

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