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내과계 중환자 섬망발생 선별모형 개발

Development of a Delirium Occurrence Screening Model for Patients in Medical Intensive Care Units

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주제분류간호학

초록

Purpose: The purpose of this study was to investigate risk factors related to delirium and to develop screening model on delirium occurrence in MICU (Medical Intensive Care Unit) patients. Methods: For developing a preliminary tool for delirium, the data of 166 patients were collected and analyzed. In order to estimate the accuracy and discriminating power for the developed screening model, 98 patients were enrolled. The data used in this study were collected by EMR (Electronic Medical Record) review from January to September in 2012. The collected data were analyzed using SPSS/PC Win 18.0 program. Results: Screening model on delirium in MICU patients was developed using the results of logistic regression. The total score of screening model was 24 point and measuring point was 10 point. When the measuring point is over 10 point, it means that the risk of delirium occurrence is high. The discriminating power and the validity of screening model showed AUC .908 (p <.001) and .935 (p <.001) respectively. This result showed that the screening model on delirium which developed in this study was an appropriate model for screening the delirium risk group in MICU. The sensitivity of the screening model was 83%, specificity 89% and accuracy 84%. Conclusion: The developed screening model on delirium occurrence in MICU should be combined with EMR for screening and preventing delirium in a high risk group.

Abstract

Purpose: The purpose of this study was to investigate risk factors related to delirium and to develop screening model on delirium occurrence in MICU (Medical Intensive Care Unit) patients. Methods: For developing a preliminary tool for delirium, the data of 166 patients were collected and analyzed. In order to estimate the accuracy and discriminating power for the developed screening model, 98 patients were enrolled. The data used in this study were collected by EMR (Electronic Medical Record) review from January to September in 2012. The collected data were analyzed using SPSS/PC Win 18.0 program. Results: Screening model on delirium in MICU patients was developed using the results of logistic regression. The total score of screening model was 24 point and measuring point was 10 point. When the measuring point is over 10 point, it means that the risk of delirium occurrence is high. The discriminating power and the validity of screening model showed AUC .908 (p <.001) and .935 (p <.001) respectively. This result showed that the screening model on delirium which developed in this study was an appropriate model for screening the delirium risk group in MICU. The sensitivity of the screening model was 83%, specificity 89% and accuracy 84%. Conclusion: The developed screening model on delirium occurrence in MICU should be combined with EMR for screening and preventing delirium in a high risk group.

참고문헌 (30)

  1. Aldemir, M., "Predisposing factors for delirium in the surgical intensive care unit", Critical Care, 5(5), pp.265~270 (2001)
  2. American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (2000), American Psychiatric Press
  3. Dubois, M. J., "Delirium in an intensive care unit : A study of risk factors", Intensive Care Medicine, 27(8), pp.1297~1304 (2001)
  4. Ely, E. W., "Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients", Critical Care Medicine, 35(1), pp.112~117 (2007)
  5. Ely, E. W., "Delirium in mechanically ventilated patients : Validity and reliability of the confusion assessment method for the intensive care unit(CAM-ICU)", Journal of American Medical Association, 286(21), pp.2703~2710 (2001)
  6. Ely, E. W., "Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit", The Journal of the American Medical Association, 291(14), pp.1753~1762 (2004)
  7. Gaudreau, J. D., "Fast, systematic, and continuous delirium assessment in hospitalized patients : The nursing delirium screening scale", Journal of Pain and Symptom Management, 29(4), pp.368~375 (2005)
  8. Heo, E. Y., "Translation and validation of the korean confusion assessment method for the intensive care uint", BioMed Central Psychiatry, 11, pp.94~97 (2011)
  9. Jacobi, J., "Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult", Critical Care Medicine, 30(1), pp.119~141 (2002)
  10. Justic, M., "Does"ICU Psychosis"Really Exist?", Critical Care Nurse, 20(3), pp.28~39 (2000)
  11. Kim, A. R., "Delirium among Elderly Patients in the Intensive Care Units", 석사, pp.2010
  12. 김경남, "한국어판 간호 섬망 선별 도구 개발 및 검증", Journal of Korean Academy of Nursing, 42(3), pp.414~423 (2012), 한국간호과학회
  13. Kim, Y. S., "Adequacy of the braden scale for intensive care patients", 석사, pp.2011
  14. Knaus, W. A., "APACHE II : A severity of disease classification system", Critical Care Medicine, 13(10), pp.818~829 (1985)
  15. Kress, J. P., "Sedation in the mechanically ventilated patient", Critical Care Medicine, 34(10), pp.2541~2546 (2006)
  16. McNicoll, L., "Delirium in the intensive care unit : Occurrence and clinical course in older patients", Journal of American Geriatrics Society, 51(5), pp.591~598 (2003)
  17. Micek, S. T., "Delirium as detected by the CAM-ICU predicts restraint use among mechanically ventilated medical patients", Critical Care Medicine, 33(6), pp.1260~1265 (2005)
  18. 문경자, "중환자실 섬망예방을 위한 근거중심 간호중재 프로토콜 개발", 임상간호연구, 16(3), pp.175~186 (2010), 병원간호사회
  19. Nijs, N., "Incidence and risk factors for pressure ulcers in the intensive care unit", Journal of Clinical Nursing, 18(9), pp.1258~1266 (2009)
  20. Ouimet, S., "Incidence, risk factors and consequences of ICU delirium", Intensive Care Medicine, 33(1), pp.66~73 (2007)
  21. Pandharipande, P., "Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients", Anesthesiology, 104(1), pp.21~26 (2006)
  22. Roberts, B. L., "Managing delirium in adult intensive care patients", Critical Care Nurse, 21(1), pp.48~55 (2001)
  23. Seo, K. S., "Factors related to delirium occurrence in medical intensive care unit patients", 석사, pp.2008
  24. Swets, J. A., "Measuring the accuracy of diagnostic systems", Science, 240(4857), pp.1285~1293 (1988)
  25. Thomason, J. W., "Intensive Care unit delirium is an independent predictor of longer hospital stay : A Prospective analysis of 261 non-ventilated patients", Critical Care, 9(4), pp.375~381 (2005)
  26. Tsuruta, R., "Prevalence and associated factors for delirium in critically ill patients at a Japanese intensive care unit", General Hospital Psychiatry, 32(6), pp.607~611 (2010)
  27. Van Rompaey, B., "Risk factors for delirium in intensive care patients : A prospective cohort study", Critical Care, 13(3), pp.1~12 (2009)
  28. Van Rompaey, B., "Risk factors for intensive care delirium : A systematic review", Intensive and Critical Care Nursing, 24(2), pp.98~107 (2008)
  29. Yu, K. D., "Delirium in acute elderly care unit; Prevalence, clinical characteristics, risk factor and prognostic significance", Journal of Korean Geriatric Psychiatry, 9(3), pp.182~189 (2005)
  30. Yu, M. Y., "Related factor of delirium occurrence in the intensive care unit patients", 석사, pp.2007

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