Clinical Research On Application Of The Simplified Chinese Version Of Nu-DESC And Simplified Chinese Version ICDSC In Evaluateing ICU Delirium

Objective To investigate the clinical value of the simplified Chinese version ofNu-DESC and simplified Chinese version ICDSC assessment of ICU delirium in domesticICU, and provide easy ICU delirium assessment tool for clinical nurses. Analyze risk factorsof occurring delirium in ICU and provide scientific basis in preventing and caringinterventions for nurses. Methods Use simplified Chinese version of Nu-DESC andsimplified Chinese version ICDSC to assess patients in domestic ICU from March2011toSeptember2011, compare with the gold standard DSM-IV diagnosis results. Evaluate theirvalidity, reliability and effectiveness and analyze their application value in ICU. Analyzegeneral information and laboratory test of patients to figure out the risk factors associatedwith ICU delirium. Results The simplified Chinese version of Nu-DESC the area under theROC curve0.951,sensitivity of82%,specificity of90%,false negative rate of18%,falsepositive rate of10%,the diagnostic index was172%,Youden’s index of0.72,positivelikelihood ratio was7.99,negative likelihood ratio was0.20,agreement rate of87%,Kappavalue of0.71,positive predictive value was77%,negative predictive value was92%.Simplified Chinese version ICDSC the area under the ROC curve0.933, sensitivity of96%,specificity of80%,false negative rate of4%,false positive rate of20%,the diagnosticindex was176%,Youden’s index of0.76,positive likelihood ratio was4.90,negative likelihoodratio was0.50,agreement rate of86%,Kappa value of0.70,positive predictive value was71%,negative predictive value was98%. Logistic regression analysis showed thatethnicity(OR0.225,95%CL0.101～0.500), education level(OR1.492,95%CL1.155～1.928), diabetes(OR0.143,95%CL0.042～0.488), hypertension(OR0.338,95%CL0.129～0.882),fever(OR2.384,95%CL1.276～4.457), APACHE II score(OR0.736,95%CL0.680～0.796),calcium(OR1.804,95%CL1.027～3.166), cholinesterase(OR2.322,95%CL1.342～4.017),aspartate aminotransferase/alanine aminotransferase(OR0.373,95%CL0.220～0.632),whiteblood cell count(OR0.467,95%CL0.277～0.789) into the regression equation. ConclusionSimplified Chinese version of Nu-DESC and simplified Chinese version of ICDSC can easilybe accepted by clinical nurses for their have simple entries, are less time-consuming, andeasily to be understood and used. They can be used as an assessment tool for nurses to judgewhether the patient have ICU delirium, and can easily be promoted domestically. They havegood reliability. Clinical experiment shows that they have good validity, reliability,effectiveness and benefits. Compare the two, simplified Chinese version of Nu-DESC costless time, but simplified Chinese version of ICDSC had higher sensitivity which reducedmisdiagnose rate. Accounting on the good results by early diagnose and interference for ICUdelirium, choose assessment standard with higher sensitivity to diagnose all suspect.Therefore, recommend simplified Chinese version of ICDSC as first choice for clinical nursesto assess ICU delirium. For knowing risk factors of ICU delirium is the prerequisites fortaking interventions. Knowing risk factors of ICU delirium provide theoretical basis for ICUnurses taking appropriate prevention and intervention measures to reduce the incidence ofICU delirium and improve prognosis of ICU delirium.