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Free AccessOriginalarbeit

Interrater Reliabilität und Übereinstimmungsvalidität des 4AT zur Erfassung des postoperativen Delirs

Eine Kohortenstudie

Published Online:May 03, 2023https://doi.org/10.1024/1012-5302/a000939

Abstract

Zusammenfassung.Hintergrund: Zahlreiche Instrumente zur Erkennung eines postoperativen Delirs sind verfügbar. Leitlinien empfehlen die Benutzung des 4 A’s Test (4AT). Allerdings gibt es kaum Evidenz zur Validität und Reliabilität des deutschsprachigen 4AT. Fragestellung/Ziel: Die Zielsetzung war, die Interrater-Reliabilität des deutschsprachigen 4AT zur Erkennung eines postoperativen Delirs bei allgemeinchirurgischen und orthopädisch-traumatologischen Patient_innen und die Übereinstimmungsvalidität mit der Delirium Observation Screening (DOS)-Skala zu überprüfen. Methoden: Die Arbeit ist Teil einer prospektiven Kohortenstudie. Die Stichprobe bestand aus 202 stationären Patient_innen (≥ 65 Jahre), die einem chirurgischen Eingriff unterzogen wurden. Die Interrater-Reliabilität des 4AT (Intraklassenkoeffizient) wurde bei 33 Patient_innen durch zwei Krankenpfleger_innen überprüft. Die Übereinstimmungsvalidität zwischen der DOS und dem 4AT wurde anhand des Korrelationskoeffizienten nach Pearson berechnet. Ergebnisse: Die Interrater-Reliabilität für den 4AT-Gesamtwert und der dichotomisierte Gesamtwert lagen bei 0,92 (95%-KI: 0,84–0,96) und 0,98 (95%-KI: 0,95–0,98). Die Korrelation zwischen DOS und 4AT betrug 0,54 (p < 0,001). Schlussfolgerungen: Der 4AT kann als Screening-Instrument zur postoperativen Delirerkennung durch das Krankenpflegepersonal bei älteren, allgemeinchirurgischen und orthopädisch-traumatologischen Patient_innen eingesetzt werden. Allerdings besteht bei positiven 4AT-Ergebnissen die Notwendigkeit eines weiterführenden Assessments durch Pflegeexpert_innen oder Ärzt_innen.


Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study

Abstract.Background: Numerous tools for detecting postoperative delirium are available. Guidelines recommend the 4 A’s Test (4AT). However, there is little evidence on the validity and reliability of the German version of 4AT. Aim: To assess the interrater reliability of the German version of 4AT test for the detection of postoperative delirium in general surgical and orthopedic-traumatological patients, and the concurrent validity with the Delirium Observation Screening Scale (DOS). Methods: The present work is part of a prospective cohort study with a sample of 202 inpatients (≥ 65 years) who underwent surgery. The interrater reliability of the 4AT (intraclass coefficients) was determined with a subsample of 33 subjects who were rated by two nurses. Concurrent validity between the DOS scale and the 4AT was calculated using Pearson’s correlation coefficient. Results: Interrater reliability for the 4AT total score and dichotomized total score were 0.92 (95% CI 0.84–0.96) and 0.98 (95% CI 0.95–0.98), respectively. The correlation between DOS and 4AT (Pearson) was 0.54 (p < 0.001). Conclusions: The 4A test can be used by nurses as a screening instrument for the detection of postoperative delirium in older patients on general surgery and orthopedic traumatology wards. In case of positive 4AT results further assessment by nurse experts or physicians is required.

Literatur

  • Bellelli, G. , Morandi, A. , Davis, D. H. , Mazzola, P. , Turco, R. , Gentile, S. , Ryan, T. , Cash, H. , Guerini, F. , Torpilliesi, T. , Del Santo, F. , Trabucchi, M. , Annoni, G. & MacLullich, A. M. (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing, 43(4), 496–502. https://doi.org/10.1093/ageing/afu021 First citation in articleCrossref Medline, Google Scholar

  • Chaiwat, O. , Chanidnuan, M. , Pancharoen, W. , Vijitmala, K. , Danpornprasert, P. , Toadithep, P. & Thanakiattiwibun, C. (2019). Postoperative delirium in critically ill surgical patients: incidence, risk factors, and predictive scores. BMC Anesthesiology, 19(1), 39–39. https://doi.org/10.1186/s12871-019-0694-x First citation in articleGoogle Scholar

  • Chang, Y. , Ragheb, S. M. , Oravec, N. , Kent, D. , Nugent, K. , Cornick, A. , Hiebert, B. , Rudolph, J. L. , MacLullich, A. M. J. & Arora, R. C. (2021). Diagnostic accuracy of the "4 A’s Test" delirium screening tool for the postoperative cardiac surgery ward. The Journal of Thoracic and Cardiovascular Surgery. https://doi.org/https://doi.org/10.1016/j.jtcvs.2021.05.031 First citation in articleGoogle Scholar

  • Charan, J. , & Biswas, T. (2013). How to Calculate Sample Size for Different Study Designs in Medical Research? Indian Journal of Psychological Medicine, 35(2), 121–126. https://doi.org/10.4103/0253-7176.116232 First citation in articleCrossref Medline, Google Scholar

  • De, J. & Wand, A. P. F. (2015). Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. The Gerontologist, 55(6), 1079–1099. https://doi.org/10.1093/geront/gnv100 First citation in articleCrossref Medline, Google Scholar

  • De, J. , Wand, A. P. F. , Smerdely, P. I. & Hunt, G. E. (2017). Validating the 4A’s test in screening for delirium in a culturally diverse geriatric inpatient population. International Journal of Geriatric Psychiatry, 32(12), 1322–1329. https://doi.org/10.1002/gps.4615 First citation in articleCrossref Medline, Google Scholar

  • Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) & Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) (2020). S3-Leitlinie Analgesie, Sedierung und Delirmanagement in der Intensivmedizin (DAS-leitlinie 2020). (https://www.awmf.org/uploads/tx_szleitlinien/001-012l_S3_Analgesie-Sedierung-Delirmanagement-in-der-Intensivmedizin-DAS_2021-08.pdf) First citation in articleGoogle Scholar

  • Hasemann, W. , Kressig, R. W. , Ermini-Funfschilling, D. , Pretto, M. & Spirig, R. (2007). Screening, Assessment und Diagnostik von Delirien. Pflege, 20(4), 191–204. https://doi.org/10.1024/1012-5302.20.4.191 (Screening, Assessment und Diagnostik von Delirien.) First citation in articleLink, Google Scholar

  • Hasemann, W. , Tolson, D. , Godwin, J. , Spirig, R. , Frei, I. A. & Kressig, R. W. (2018). Nurses’ Recognition of Hospitalized Older Patients With Delirium and Cognitive Impairment Using the Delirium Observation Screening Scale: A Prospective Comparison Study. Journal of Gerontological Nursing, 44(12), 35–43. https://doi.org/10.3928/00989134-20181018-02 First citation in articleCrossref Medline, Google Scholar

  • Helfand, B. K. I. , D’Aquila, M. L. , Tabloski, P. , Erickson, K. , Yue, J. , Fong, T. G. , Hshieh, T. T. , Metzger, E. D. , Schmitt, E. M. , Boudreaux, E. D. , Inouye, S. K. & Jones, R. N. (2021). Detecting Delirium: A Systematic Review of Identification Instruments for Non-ICU Settings. Journal of the American Geriatrics Society, 69(2), 547–555. https://doi.org/10.1111/jgs.16879 First citation in articleCrossref Medline, Google Scholar

  • Inouye, S. , Westendorp, R. G. J. & Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383(9920), 911–922. https://doi.org/10.1016/S0140-6736(13)60688-1 First citation in articleCrossref Medline, Google Scholar

  • Johansson, Y. A. , Tsevis, T. , Nasic, S. , Gillsjö, C. , Johansson, L. , Bogdanovic, N. & Kenne Sarenmalm, E. (2021). Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting. BMC Geriatrics, 21(1), 568. https://doi.org/10.1186/s12877-021-02493-3 First citation in articleCrossref Medline, Google Scholar

  • Kottner, J. , Audigé, L. , Brorson, S. , Donner, A. , Gajewski, B. , Hróbjartsson, A. , Roberts, C. , Shoukri, M. & Streiner, D. L. (2011). Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Journal of Clinical Epidemiology, 64(1), 96–106. https://doi.org/https://doi.org/10.1016/j.jclinepi.2010.03.002 First citation in articleCrossref Medline, Google Scholar

  • Kuladee, S. & Prachason, T. (2016). Development and validation of the Thai version of the 4 ’A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses. Neuropsychiatric Disease and Treatment, 12, 437–443. https://doi.org/10.2147/ndt.s97228 First citation in articleCrossref Medline, Google Scholar

  • MacLullich, A. M. J. , Shenkin, S. D. , Goodacre, S. , Godfrey, M. , Hanley, J. , Stíobhairt, A. , Lavender, E. , Boyd, J. , Stephen, J. , Weir, C. , MacRaild, A. , Steven, J. , Black, P. , Diernberger, K. , Hall, P. , Tieges, Z. , Fox, C. , Anand, A. , Young, J. , … Gray, A. (2019). The 4 "a"s test for detecting delirium in acute medical patients: A diagnostic accuracy study. Health Technology Assessment, 23(40), 1–193. https://doi.org/ http://doi.org/10.3310/hta23400 First citation in articleCrossref Medline, Google Scholar

  • Muser, O. , Seiler, K. , Bachnick, S. , Gehri, B. , Zuniga, F. & Hasemann, W. (2022). Delirium detection in hospitalized adults: the performance of the 4 ’A’s Test and the modified Confusion Assessment Method for the Emergency Department. A comparison study. Bulletin of the National Research Centre, 46. https://doi.org/10.1186/s42269-022-00863-4 First citation in articleCrossref, Google Scholar

  • National Institute for Health and Care Excellence [NICE]. (2019). Delirium: prevention, diagnosis and management. First citation in articleGoogle Scholar

  • National Institute for Health and Care Excellence, [NICE]. (2020). 2020 exceptional surveillance of delirium: prevention, diagnosis and management (NICE guideline CG103). www.nice.org.uk First citation in articleGoogle Scholar

  • Park, J. , Jeong, E. & Lee, J. (2021). The Delirium Observation Screening Scale: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. Clinical Nursing Research, 30(4), 464–473. https://doi.org/10.1177/1054773820961234 First citation in articleCrossref Medline, Google Scholar

  • Polit, D. F. & Tatano Beck, C. (2004). Nursing Research: Principles and Methods – 7th edition (L.-R. Publishers, Ed. 7TH 04 ed.). First citation in articleGoogle Scholar

  • Portney, L. G. & Watkins, M. P. (2015). Foundation of Clinical Research (Application to practice). F. A. Davis Company. First citation in articleGoogle Scholar

  • Rieck, K. M. , Pagali, S. & Miller, D. M. (2020). Delirium in hospitalized older adults. Hospital Practice, 48(sup1), 3–16. https://doi.org/10.1080/21548331.2019.1709359 First citation in articleCrossref, Google Scholar

  • Saller, T. , MacLullich, A. M. J. , Schafer, S. T. , Crispin, A. , Neitzert, R. , Schule, C. , von Dossow, V. & Hofmann-Kiefer, K. F. (2019). Screening for delirium after surgery: validation of the 4 A’s test (4AT) in the post-anaesthesia care unit. Anaesthesia. https://doi.org/10.1111/anae.14682 First citation in articleCrossref Medline, Google Scholar

  • Scottish Intercollegiate Guidelines Network, [SIGN]. (2019). Risk reduction and management of delirium. http://www.sign.ac.uk First citation in articleGoogle Scholar

  • Shenkin, S. D. , Fox, C. , Godfrey, M. , Siddiqi, N. , Goodacre, S. , Young, J. , Anand, A. , Gray, A. , Hanley, J. , MacRaild, A. , Steven, J. , Black, P. L. , Tieges, Z. , Boyd, J. , Stephen, J. , Weir, C. J. & MacLullich, A. M. J. (2019). Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method. BMC Medicine, 17(1), 138. https://doi.org/10.1186/s12916-019-1367-9 First citation in articleCrossref Medline, Google Scholar

  • Siddiqi, N. , Harrison, J. K. , Clegg, A. , Teale, E. A. , Young, J. , Taylor, J. & Simpkins, S. A. (2016). Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Systematic Review, 3, CD005563. https://doi.org/10.1002/14651858.CD005563.pub3 First citation in articleMedline, Google Scholar

  • Temel, G. & Erdogan, S. (2017). Determining the sample size in agreement studies. Marmara Medical Journal, 30, 101–112. https://doi.org/10.5472/marumj.344822 First citation in articleCrossref, Google Scholar

  • Tieges, Z. , Lowrey, J. & MacLullich, A. M. J. (2021b). What delirium detection tools are used in routine clinical practice in the United Kingdom? Survey results from 91% of acute healthcare organisations. European geriatric medicine. https://doi.org/https://doi.org/10.1007/s41999-021-00507-2 First citation in articleCrossref, Google Scholar

  • Tieges, Z. , MacLullich, A. M. J. , Anand, A. , Brookes, C. , Cassarino, M. , O’Connor, M. , Ryan, D. , Saller, T. , Arora, R. C. , Chang, Y. , Agarwal, K. , Taffet, G. , Quinn, T. , Shenkin, S. D. & Galvin, R. (2021a). Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age and Ageing, 50(3), 733–743. https://doi.org/10.1093/ageing/afaa224 First citation in articleCrossref Medline, Google Scholar

  • van Velthuijsen, E. L. , Zwakhalen, S. M. , Warnier, R. M. , Mulder, W. J. , Verhey, F. R. & Kempen, G. I. (2016). Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review. International Journal of Geriatric Psychiatry, 31(9), 974–989. https://doi.org/10.1002/gps.4441 First citation in articleCrossref Medline, Google Scholar