谵妄患者注意力障碍检查方法一致性的临床研究

A clinical study on the consistency of the methods for detecting attention deficit disorder of delirium

目的评估谵妄特征注意力障碍检查方法的一致性。方法选取进入自贡市第四人民医院重症医学科患者1205例,分别应用CAM-ICU中的字母法、数学字法、注意力筛查图片法A(Attention Screening Exam Visual Form A,ASE A)、注意力筛查图片法B(Attention Screening Exam Visual Form B,ASE B)检查患者的注意力障碍,对比这些检查方法在不同文化程度、不同自贡市内地区在检查注意力障碍时的一致性。结果数字法与字母法的相关系数为0.633,数字法与注意力筛查图片法A的相关系数为0.663,数字法与注意力筛查图片法B的相关系数0.672,一致性系数(Kappa值)分别为0.808、0.884和0.906。结论 CAM-ICU中的数字法与ASE B一致性好,对不同文化程度、自贡不同地区患者分析对比中,提示ASE B为最适合检查注意力障碍的方法。

Objective To evaluate the consistency of the methods assess attention disorder for patients with delirium.Methods 1205 patients hospitalized in the department of critical care medicine of Zigong Fourth People＇s Hospital were included in this study. These patients were examined for attention deficit disorder by means of Letter method, Digital method, Attention Screening Exam Visual Form A （ ASE A ） and Attention Screening Exam Visual Form B （ ASE B ） from confusion assessment method for intensive care unit （ CAM - ICU ）. We compared the consistency of these examinations under different educational levels and in different areas of Zigong. Results The dependence coefficient of the two methods （ Letter method and Digital method） was 0.633, it was 0.663 between Digital method and ASE A, then it was 0.672 between the Digital method and ASE B. The Kappa value were 0.808, 0.884 and 0.906. We take ASE B as the standard for the consistency of ASE B is the best. We obtained the results by analysis. The sensitivity of the digital method for the assessment of attention deficit disorder was 96.1%, the specificity was 94.6%, the missed diagnosis rate was 3.9%, and the misdiagnosis rate was 5.4%. Conclusions The consistency between the Digital method and ASE B from CAM-ICU is best, and ASE B is the most suitable method for the detection of attention deficit disorder in Patients with different educational levels or different areas of Zigong.