期刊
JOURNAL OF CRITICAL CARE
卷 48, 期 -, 页码 104-111出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2018.08.019
关键词
Delirium; Cognitive Assessment; Smartphone; Attention Impairments; Arousal; Case-Control Study
资金
- Medical Research Council Centenary Early Career Award
- Biotechnology and Biological Sciences Research Council and Medical Research Council, cross council Lifelong Health and Wellbeing Initiative [MR/K026992/1]
- MRC [G108/646, MR/L023210/1] Funding Source: UKRI
Purpose: Delirium in the ICU is under-diagnosed. We evaluated feasibility and performance of a novel smartphone-based test for objectively detecting inattention in delirium. Material and methods: DelApp-ICU combines a behavioural assessment and an attention task, whereby participants follow simple commands and count serially presented circles (score range 0-12, lower scores indicating worse performance). We assessed feasibility through staff interviews. Then we performed a preliminary case-control study in patients with and without delirium (ascertained with the Confusion Assessment Method for the ICU) who underwent the DelApp-ICU on up to 4 days. Results: Forty-six patients (median age = 57.5 years, range 18-83) were assessed 89 times in total (N's 46, 29, 10 and 4 for subsequent assessments; 33.7% delirious). DelApp-ICU scores were lower in delirium (N = 20; median = 0.5, Inter-Quartile Range (IQR) = 0-4.75) compared to no delirium (N = 26, median = 12, IQR = 8-12) on days 1, 2 and 3 (p < 0.001, p < 0.001 and p < 0.05, respectively). A DelApp-ICU score 5.6 was 100% sensitive and 96% specific to delirium on day 1. Positive and Negative Predictive Values were 91% and 100%, respectively. DelApp-ICU scores were responsive to changes in CAM-ICU status. Conclusions: DelApp-ICU shows promise for assessing inattention and delirium in ICU patients, including longitudinally monitoring deficits and providing a metric of delirium severity. (C) 2018 Elsevier Inc. All rights reserved.
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