成人患者谵妄管理指南的质量评价

Quality assessment of the guidelines for the management of delirium in adult patients

目的系统评价近十年成人患者谵妄管理指南的质量,为相关指南的更新、选择、应用及谵妄管理提供参考。方法计算机检索PubMed、EMbase、WanFang Data、CNKI数据库及国内外相关指南库,搜集成人患者谵妄管理指南,检索时限均从2010年1月1日至2019年9月1日,由2位评价员独立筛选文献、提取资料并运用AGREEⅡ对纳入文献进行质量评价。结果各指南中,总得分较高的为来自NICE、RNAO和SIGN的3个指南,得分较低的为来自CSCCM和IPS的指南。AGREEⅡ各领域中,得分较高的为领域一(范围和目的)和领域四(清晰性),最低为领域二(参与人员)和领域五(应用性)。纳入指南对于谵妄管理主要集中于筛查、预测、药物和非药物预防与治疗以及信息支持方面。结论未来谵妄管理指南制定应遵循指南制订和更新的方法学指导,同时加强对指南各领域,尤其是应用性方面的描述。应在质量较高的指南基础上构建适用于国内患者的谵妄指南或临床实践方案,以促进知识转化,优化谵妄管理。

Objective To evaluate the quality of guidelines for the management of delirium in adult patients in the last ten years, so as to provide references for updating, selection, implementation guidelines and delirium management optimization. Methods We searched guidelines from databases including PubMed, EMbase, WanFang Data and CNKI,and websites of guidelines from January 1st 2010 to September 1st 2019. Guidelines were comprehensively screened,evaluated based on AGREE Ⅱ and data was independently extracted by two researchers. Results Guidelines of NICE,RNAO and SIGN had higher scores, while CSCCM’s and IPS’s gained lower. Among domains of AGREE Ⅱ, Domain Ⅰ(scope and purpose) and Ⅳ(clarity of presentation) scored the highest, with a minimum of Domain Ⅱ(stakeholder involvement) and Ⅴ(applicability). Delirium management focused on screening, prediction, prevention and treatment both pharmacologically and non-pharmacologically, and information support. Conclusions Future development of delirium guidelines should follow the methodology of guideline development, update or adjustment, and dedicate to every domain, especially domain of application. Medical staffs can establish our own domestic guidelines based on high quality guidelines, to promote knowledge translation and delirium management.