Assessment of Instruments for Measurement of Delirium Severity A Systematic Review

被引：70

作者：

Jones, Richard N. ^{[1
,2
,24
]}

Cizginer, Sevdenur ^{[3
,24
]}

Pavlech, Laura ^{[4
]}

Albuquerque, Asha ^{[5
]}

Daiello, Lori A. ^{[2
]}

Dharmarajan, Kumar ^{[6
]}

Gleason, Lauren J. ^{[7
]}

Helfand, Benjamin ^{[1
,2
,8
]}

Massimo, Lauren ^{[9
]}

Oh, Esther ^{[10
]}

Okereke, Olivia I. ^{[11
,12
,13
]}

Tabloski, Patricia ^{[14
,27
]}

Rabin, Laura A. ^{[15
,16
]}

Yue, Jirong ^{[17
]}

Marcantonio, Edward R. ^{[18
,19
,23
]}

Fong, Tamara G. ^{[5
,13
,19
,22
,23
]}

Hshieh, Tammy T. ^{[5
,19
,20
,25
]}

Metzger, Eran D. ^{[19
,21
]}

Erickson, Kristen ^{[5
]}

Schmitt, Eva M. ^{[5
,22
]}

Inouye, Sharon K. ^{[5
,18
,19
,22
,23
]}

Racine, Annie ^{[19
,22
]}

Schulman-Green, Dena ^{[26
]}

Travison, Thomas ^{[19
,22
]}

Vasunilashorn, Sarinnapha ^{[19
,23
]}

Abrantes, Tatiana ^{[22
]}

Armstrong, Brett ^{[23
]}

Bertrand, Sylvia ^{[22
]}

Butters, Angelee ^{[23
]}

D'Aquila, Madeline ^{[22
]}

Gallagher, Jacqueline ^{[23
]}

Kettell, Jennifer ^{[22
]}

Nee, Jacqueline ^{[22
]}

Parisi, Katelyn ^{[22
]}

Vella, Margaret ^{[22
]}

Xu, Guoquan ^{[22
]}

Weiner, Lauren ^{[23
]}

Gou, Yun ^{[22
]}

Tommet, Douglas ^{[24
]}

Brown, Charles H. ^{[28
]}

Cizginer, Sevdenur ^{[3
,24
]}

Clark, Diane ^{[29
]}

Flaherty, Joseph H. ^{[30
]}

Gleason, Anne ^{[22
]}

Kolanowski, Ann M. ^{[31
]}

Neufeld, Karen J. ^{[28
]}

O'Connor, Margaret G. ^{[23
]}

Pisani, Margaret A. ^{[26
]}

Robinson, Thomas ^{[32
]}

Verghese, Joe ^{[33
]}

机构：

[1] Brown Univ, Dept Psychiat & Human Behav, Warren Alpert Med Sch, Providence, RI 02912 USA

[2] Brown Univ, Rhode Isl Hosp, Warren Alpert Med Sch, Dept Neurol, Providence, RI 02903 USA

[3] Brown Univ, Dept Med, Warren Alpert Med Sch, Div Geriatr & Palliat Med, Providence, RI 02912 USA

[4] Tufts Univ, Hirsh Hlth Sci Lib, Boston, MA 02111 USA

[5] Hebrew SeniorLife, Aging Brain Ctr, Inst Aging Res, 1200 Ctr St, Boston, MA 02459 USA

[6] Yale Univ, Sch Med, Ctr Outcomes Res & Evaluat, New Haven, CT USA

[7] Univ Chicago Med, Dept Med, Sect Geriatr & Palliat Med, Chicago, IL USA

[8] Univ Massachusetts, Sch Med, Worcester, MA USA

[9] Univ Penn, Sch Med, Frontotemporal Degenerat Ctr, Philadelphia, PA 19104 USA

[10] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[11] Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA

[12] Massachusetts Gen Hosp, Dept Psychiat, Boston, MA 02114 USA

[13] Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA 02215 USA

[14] Boston Coll, Connell Sch Nursing, Chestnut Hill, MA 02167 USA

[15] CUNY, Brooklyn Coll, Dept Psychol, Brooklyn, NY 11210 USA

[16] CUNY, Grad Ctr, Brooklyn, NY 11210 USA

[17] Sichuan Univ, West China Hosp, Dept Geriatr, Chengdu, Sichuan, Peoples R China

[18] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[19] Harvard Med Sch, Boston, MA USA

[20] Brigham & Womens Hosp, Dept Med, Div Aging, 75 Francis St, Boston, MA 02115 USA

[21] Beth Israel Deaconess Med Ctr, Dept Psychiat, Boston, MA 02215 USA

[22] Hebrew SeniorLife, Boston, MA USA

[23] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[24] Brown Univ, Providence, RI 02912 USA

[25] Brigham & Womens Hosp, Boston, MA 02115 USA

[26] Yale Univ, New Haven, CT 06520 USA

[27] Boston Coll, Chestnut Hill, MA 02167 USA

[28] Johns Hopkins Univ, Baltimore, MD 21218 USA

[29] Univ Alabama, Tuscaloosa, AL 35487 USA

[30] St Louis Univ, St Louis, MO 63103 USA

[31] Penn State Univ, University Pk, PA 16802 USA

[32] Univ Colorado, Boulder, CO 80309 USA

[33] Albert Einstein Coll Med, Bronx, NY USA

[34] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA

来源：

JAMA INTERNAL MEDICINE | 2019年 / 179卷 / 02期

基金：

美国国家卫生研究院;

关键词：

CONFUSION ASSESSMENT METHOD; METHODOLOGICAL QUALITY; SCORING SYSTEM; RATING-SCALE; VALIDATION; TOOLS; DEMENTIA; COHORT;

D O I：

10.1001/jamainternmed.2018.6975

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition. OBJECTIVES To present a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments. EVIDENCE REVIEW This systematic review was conducted using literature from Embase, PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature, from January 1, 1974, through March 31, 2017, with the key words delirium, severity, tests, measures, and intensity. Inclusion criteria were original articles assessing delirium severity and using a delirium-specific severity instrument. Final listings of articles were supplemented with hand searches of reference listings to ensure completeness. At least 2 reviewers independently completed each step of the review process: article selection, data extraction, and methodologic quality assessment of relevant articles using a validated rating scale. All discrepancies between raters were resolved by consensus. FINDINGS Of 9409 articles identified, 228 underwent full text review, and we identified 42 different instruments of delirium severity. Eleven of the 42 tools were multidomain, delirium-specific instruments providing a quantitative rating of delirium severity; these instruments underwent a methodologic quality review. Applying prespecified criteria related to frequency of use, methodologic quality, construct or predictive validity, and broad domain coverage, an expert panel used an iterative modified Delphi process to select 6 final high-quality instruments meeting these criteria: the Confusion Assessment Method-Severity Score, Confusional State Examination, Delirium-O-Meter, Delirium Observation Scale, Delirium Rating Scale, and Memorial Delirium Assessment Scale. CONCLUSIONS AND RELEVANCE The 6 instruments identified may enable accurate measurement of delirium severity to improve clinical care for patients with this condition. This work may stimulate increased usage and head-to-head comparison of these instruments.

引用

页码：231 / 239

页数：9

共 32 条

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