兒童譫妄量表臨床適用性之先驅性研究

The clinical feasibility of Pediatric Delirium Rating Scale-R-98-C (PDRS-R-98-C): A Preliminary Study

黃瓊鶯(Chiung-Ying Huang)

指導教授 ： 高碧霞

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01323

摘要

背景：加護病房急性譫妄的發生會延長住院天數、增加疾病嚴重度及醫療成本。　　對病童的身心都是很大的衝擊。而加護病房急性譫妄之相關研究卻十分有限，且大多在探討成人之急性譫妄，國內外卻無兒童相關之急性譫妄量表。
目的：本研究目的在於發展兒童版譫妄量表及量表之信度效度檢測。
研究方法：研究設計採橫斷式研究設計本研究工具參考Huang et al.（2009）之成人版譫妄量表98中文版進行量表修正，將其修正為適合臨床護理人員施測於兒童之「兒童譫妄量表」，以立意取樣方式，選取某醫學中心7-18歲住加護病房之24位重症病童為研究對象。於住加護病房期間重複施測共計37人次資料，予以SPSS 15.0 for windows統計軟體進行分析，並進行量表之信、效度檢定，包括內容效度、效標關聯效度、內在一致性、評核者一致性等。
結果：研究對象年齡介於9~18歲之間，平均年齡13.3歲(SD = 3.05)，住加護病房天數介於2~26天，平均住加護病房天數為9.83天(SD = 6.33)，24位病童中有3位病童(12.5%)住加護病房期間曾出現急性譫妄，本研究量表信效度方面：整體量表之專家內容效度(content validity index, CVI）為0.97；以精神疾病診斷準則手冊第四版（The Diagnostic and Statistical Manual of Mental Disorders, fourth edition , DSM-Ⅳ）的譫妄診斷作為效標，以Kendall's tau_b檢測結果顯示DSM-Ⅳ的譫妄診斷與兒童譫妄量表間呈現正相關，(r＝0.46，P＜0.01)；以Kappa一致性係數進行評核者間一致性檢定，結果顯示兩組施測者的評分相當一致 (κ = 0.79，P＜0.05)；本研究整體總量表之Cronbach’s α為0.94顯示本量表具足夠的內在一致性；整體量表之組內相關係數(Intra-class correlation, ICC)為0.94。
結論：研究結果顯示，兒童譫妄量表具有良好的信、效度，可應用在未來兒童譫妄之相關研究。未來的研究建議也能拓及一般病房的譫妄兒童，運用縱貫式研究以使本研究更臻完善。

關鍵字

兒童加護病房 ； 加護病房症候群 ； 急性譫妄 ； 重症照護

並列摘要

Background: The occurrence of ICU acute delirium can increase the length of hospital stay, the severity of illness and the medical costs. It has a great impact on physical and mental for children. However, the researches on the ICU delirium in children were insufficient and most of the rating scales were explored the adult and the elder patients; there was no rating useful to children.

Purposes: The purposes of this research are to develop the〝Pediatric Delirium Rating Scale〞and to evaluate its reliability and validity.

Methods: The research utilized a cross-sectional study design. This research is referring to Huang et al. (2009) (Delirium Rating Scale- Revised-98-C). The original delirium rating scale has been amended into “Pediatric Delirium Rating scale” to fit for clinical practice for nursing members to apply on pediatric patients. The data was collected from 24 patients aged among 7-18, who are receiving intensive care in a medical center in northern Taiwan. Repeated surveying has been applied during their stay in ICU, 37 person times all collected data was statistically analyzed with a SPSS 15.0 for windows software, and examined the reliability and validity of the scale, including content validity (CVI), criterion related validity, internal consistency and inter-rater reliability.

Results: This study was recruited 24 illness children, and collected 37 person-time data. These children were aged from 9 to 18 (mean=13.3, SD = 3.05). The intensive care unit stay was between 2 to 26 days (mean=9.83, SD = 6.33). There were 3 children (12.5%) had acute delirium during the admission in the intensive care unit. The content validity index (CVI) of this scale was 0.97; the criterion related validity was measured by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM-IV). It showed positive correlation between diagnosis of acute delirium and Pediatric Delirium Rating Scale as the result of Kendall's tau_b (r＝0.46，P＜0.01). According to Kappa consistency coefficient to evaluate the rater consistency, it showed consistent between the raters of these two groups (κ = 0.79，P＜0.05). The Cronbach’s α was 0.94 also showed adequate internal consistency of this rating scale. The Intra-class correlation, ICC was 0.94.

Conclusion: Study findings suggest that the “Pediatric Delirium Rating Scale Revised-98-C” has good reliability and validity. Hence, the scale can provide a basis for further study about pediatric delirium. Future researches to recruit delirium children in the general wards and to have the longitudinal study design are suggested.

並列關鍵字

pediatric intensive care unit（PICU） ； ICU syndrome ； acute delirium ； critical care

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