加護病房混亂評估量表中文版信效度測試

Evaluation of the Reliability and Validity of the Chinese Version of the Confusion Assessment Method for the Intensive Care Unit

測試中文版「加護病房混亂評估量表」（confusion assessment method for the intensive care unit, CAM-ICU），於本國使用的信度與效度，及其對譫妄的鑑別價值，該工具由Ely等人依據精神疾病診斷統計分類手冊（diagnostic and statistical manual of mental disorders, DSM）研擬而成。於南部一所醫學中心之加護病房，經立意取樣共31名病患進行測試，由兩位訪查員以中文版CAM-ICU分別收集資料，測試評分者間的一致性；以精神科醫師的DSM-Ⅳ診斷譫妄的結果為黃金標準（gold standard），進行效度檢定，計算中文版CAM-ICU用於譫妄鑑別時的敏感度、特異度等指標。中文版CAM-ICU用於譫妄的鑑別時，評分者間信度kappa統計數字為.48（p < .01）。同時效度，PABAK統計數字為.48（p < .01）與McNemar’s test為p = .72。兩位訪查員與醫師於敏感度（sensitivity）各別為89%、96%。中文版CAM-ICU能夠作為加護病房護理人員，快速與簡便的偵測譫妄的發生，以便及早介入治療，減少合併症的產生。

This study was designed to evaluate the reliability and validity of the Chinese version of the diagnostic and statistical manual (DSM) of mental disorders written by Ely et al as a confusion assessment method for the intensive care unit (CAM-ICU) for diagnosing delirium. Purposive sampling was used to recruit 31 patients in a southern medical center ICU. Data were collected by two interviewers who used CAM-ICU to test inter-rater consistency. DSM served as the delirium diagnosis standard to test CAM-ICU validity and calculate sensitivity and specificity. The inter-rater reliability Kappa value for CAM-ICU applied to delirium diagnosis was .48 (p < .01). The validity PABAK value was .48 (p < .01) and McNemar’s test value was p = .72. The sensitivity achieved by the two interviewers was 89%, versus 96% for the doctor. The CAM-ICU is a method that helps ICU nursing staff to detect occurrences of delirium rapidly and easily, permitting early intervention treatment with fewer complications.