การประเมินคัดกรองภาวะเพ้อหลังผ่าตัดด้วยเครื่องมือ 4 'A' Test ฉบับภาษาไทย ในผู้ป่วยสูงอายุที่เปลี่ยนข้อสะโพกหรือข้อเข่า

Abstract

Objective : To assess effects of postoperative delirium screening using the Thai-Version
4 ‘A’s Test (4AT-T) and survey users’ opinions on using this instrument.
Methods : Sixty-nine elderly inpatients receiving hip/knee arthroplasty were enrolled
to undergo postoperative delirium screening with the 4AT-T. Patients screened
positive were re-evaluated by a psychiatrist to confirm diagnosis based on DSM-5. The
percentage of confirmed delirium cases, length of hospital stay (LOS) and mortality
rate were collected and compared with historical control data of elderly inpatients
(n = 154) receiving the same operations during the pre-implementation period, which
were reviewed from medical records. After all the screening process, 30 experienced
nurses were surveyed for their opinion of the 4AT-T by questionnaire.
Results : The percentage of patients with delirium in the screening group was 1.3%,
comparable to 1.4% in the control group (P = 1.00). Mortality rates in both groups were
zero. The LOS (in hours) of the control group (Median = 67; Interquartile range, IQR =
23) was greater than that of the screening group (Median = 52; IQR = 25) (P = .023).
Eighty percent of the nurses agreed that the screening is easy and simple. They were
satisfied to use this instrument. However, 33.3% and 26.7% considered it to increase
excessive workloads and time-consuming, respectively.
Conclusion : The postoperative delirium screening by the 4AT-T revealed low prevalence
of delirium in this study. However, most users were satisfied to use this instrument despite
some concerns about impacts on their workload.