繁體中文版譫妄篩檢量表4AT於創傷性腦部損傷病人之信效度檢定

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題名:	繁體中文版譫妄篩檢量表4AT於創傷性腦部損傷病人之信效度檢定 Psychometric Testing of the Traditional Chinese Version of the 4 'A's Test for Delirium Screening in Patients with Traumatic Brain Injury
作者:	賴紜宣 Lai, Yun-Hsuan
貢獻者:	護理學系碩士在職專班邱曉彥
關鍵詞:	創傷性腦損傷;譫妄;4AT;信效度檢定 Traumatic brain injury;delirium;4AT;reliability and validity
日期:	2023-12-13
上傳時間:	2025-01-06
摘要:	研究背景：譫妄是一種急性認知功能障礙，於創傷性腦損傷後之發生率可高達50%。發生譫妄後，除延長病人住院時間或有較高死亡率外，出院後更可能影響病人認知功能狀態。故早期篩檢創傷性腦損傷後譫妄具有臨床重要性。4 'A's Test（4AT）是一種新的簡短、快速評估譫妄且具有良好信效度之量表，然而，4AT尚未被翻譯成繁體中文版且未於創傷性腦部損傷病人進行工具信效度驗證。研究目的：本研究目的於翻譯繁體中文版4AT譫妄篩檢量表以及進行繁體中文版4AT譫妄篩檢量表於創傷性腦損傷病人之信效度檢定。研究方法：本研究為前瞻性觀察研究，以方便取樣方式於台灣北部一家準醫學中心神經外科病房及南部一家區域教學醫院外科病房進行收案。病人年齡大於等於20歲、具創傷性腦部損傷診斷且格拉斯哥昏迷量表為13-15分將納入本研究。本研究共分為二階段，第一階段是4AT繁體中文版翻譯過程；第二階段是進行繁體中文版4AT信度和效度檢驗，信度將採用評估者間信度，而效度以第五版精神疾病診斷與統計手冊作為黃金標準，比較繁體中文版4AT用於篩檢創傷性腦損傷後譫妄之敏感度和特異性分析。結果：本研究納入100名病人，平均年齡為67歲。其中10%病人經黃金標準診斷有譫妄症狀發生。繁體中文版譫妄篩檢量表4AT的信度以評估者間信度分析結果為1.00。接受者操作特徵曲線結果切分點為4分，敏感度和特異性分別為0.90及0.94，曲線下面積0.96。結論：繁體中文版譫妄篩檢量表於創傷性腦部損傷病人具有良好的信效度，是一種有效評估譫妄篩檢工具，可提供臨床護理師應用於譫妄預防照護前之評估及治療決策之參考。 Background: Delirium is an acute cognitive impairment, with an incidence of up to 50% following traumatic brain injury (TBI). Following the occurrence of delirium, post-TBI delirium not only prolongs hospital stay and elevates mortality rate but also impairs cognitive function after discharge. Therefore, early screening for post-TBI delirium is of clinical importance. The 4 'A's Test (4AT) is a briefly and rapidly administered scale for delirium assessment, demonstrating good reliability and validity. However, the 4AT has not yet been translated into Traditional Chinese, and its reliability and validity have not been examined in patients with TBI. Purpose: The aim of this study is to translate the 4AT delirium screening tool into Traditional Chinese (TC-4AT) and to assess its reliability and validity in patients with TBI. Methods: This study was a prospective observational study conducted through convenient sampling at the neurosurgery ward of a would-be academic medical center in Northern Taiwan and the surgical ward of a regional teaching hospital in Southern Taiwan. Patients aged 20 years and above, have been diagnosed with TBI, and having a Glasgow Coma Scale score between 13 and 15 were included. The study was divided into two phases: the first phase involved the translation process of the TC-4AT; the second phase included testing the reliability and validity of the TC-4AT. Reliability was assessed using inter-rater reliability. The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) was served as the gold standard for estimating the sensitivity and specificity of the TC-4AT for screening post-TBI delirium. Results: A total of 100 patients with an average age of 67 years were included. Among them, 10% of patients were diagnosed with delirium based on the DSM-5. The inter-rater reliability of the TC-4AT was 1.00. The Receiver Operating Characteristic curve indicated that the optimal cut-off point was 4, with the sensitivity, specificity and AUC of 0.90, 0.94, and 0.96, respectively. Conclusion: The TC-4AT yields good reliability and validity in patients with TBI. The cutoff point of 4 is used to determine patients with or without post-TBI delirium. The TC-4AT is an accurate tool for delirium assessment, offering bedside nurses a crucial reference for early detection and informed decision-making in preventive care for delirium.
描述:	碩士指導教授：邱曉彥口試委員：陳可欣口試委員：蘇亦昌口試委員：邱曉彥
附註:	論文公開日期：2029-01-09
資料類型:	thesis
顯示於類別:	[護理學系] 博碩士論文

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