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Master's Dissertation
DOI
https://doi.org/10.11606/D.7.2018.tde-10112017-042447
Document
Author
Full name
Daniele Vieira da Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2017
Supervisor
Committee
Turrini, Ruth Natalia Teresa (President)
Leite, Renata Elaine Paraizo
Nishizawa, Aline
Silva, Rita de Cassia Gengo e
Title in Portuguese
Validação do diagnóstico de enfermagem confusão crônica: um estudo clinicopatológico
Keywords in Portuguese
Confusão
Demência
Diagnóstico de Enfermagem
Estudos de Validação e Idosos
Abstract in Portuguese
Introdução: O Diagnóstico de Enfermagem Confusão Crônica (DCC) foi criado em 1994 e até o momento nenhum estudo realizou sua validação clínicopatológica. Como as principais causas de DCC são as demências, a única forma de validação, com base no diagnóstico definitivo, é a autópsia encefálica que é considerada padrão-ouro. Objetivo: Realizar a validação clínicopatológica do DCC. Método: Por meio de um estudo transversal, foram analisados 548 casos completos de indivíduos falecidos pertencentes à casuística do Banco de Encéfalos Humanos da Faculdade de Medicina da Universidade de São Paulo, no qual foram extraídos dados clínicopatológicos. O DCC foi definido em cada caso por meio de consenso diagnóstico. Para a validade de critério do DCC foram utilizados os testes de correlação, regressão logística e curva Receiver Operating Characteristic (ROC). Resultados: Dos 548 indivíduos, 26,3% tinham DCC, em relação à validade de critério, o DCC correlacionou-se com o Clinical Dementia Rating (CDR) (r = 0,68; p < 0,0001), com o Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) (r = 0,47; p < 0,0001) e obteve uma associação significativa estatisticamente com o diagnóstico neuropatológico (p < 0,0001). Os principais preditores neuropatológicos de DCC foram: Demência Vascular (OR = 18,00; p < 0,0001), Demência Mista (OR = 9,58; p < 0,0001), Degeneração Lobar Frontotemporal (OR = 9,58; p = 0,004) e Doença de Alzheimer (OR = 9,00; p < 0,0001). A melhor capacidade preditiva foi para o diagnóstico de Demência Vascular (AUC = 0,717; IC 95% 0,629-0,806). Ter DCC presente aumenta em 7,16 vezes a chance de apresentar alteração neuropatológica compatível com doença neurodegenerativa. Conclusão: De um modo geral, o DCC apresenta boas evidências de validade de critério em relação ao diagnóstico padrão-ouro das principais doenças neurodegenerativas. No entanto, ainda carece de refinamento e melhor exploração de suas características definidoras de modo a ampliar sua capacidade diagnóstica em relação a outras condições neurodegenerativas. Os fatores relacionados apresentados no DCC aprovado pela NANDA Internacional, Inc. (NANDA-I) necessitam de revisão, a partir dos resultados do presente estudo.
Title in English
Validation of the Nursing Diagnosis Chronic Confusion: a clinical-pathological study
Keywords in English
Confusion
Dementia
Nursing Diagnosis
Validation Studies and Elderly
Abstract in English
Introduction: The Nursing Diagnosis Chronic Confusion (NDCC) was first introduced in 1994 and, to date, no study has performed its clinical-pathological validation. As the main cause of NDCC is dementia, the only way to validate it, based on their definitive diagnosis is by brain autopsy that is considered the gold standard. Objective: This studys objective was to perform the clinical-pathological validation of NDCC. Method: Through a cross-sectional study, 548 complete cases of deceased individuals that belongs to the Human Brain Bank of the Brazilian Aging Brain Study Group, Medicine School of the University of São Paulo were analyzed, in which clinical and pathological data were extracted. The NDCC was defined to each case by a consensus diagnostic. For criteriom validity of the NDCC, correlation, logistic regression and ROC curve tests were used. Results: Of the 548 subjects, 26.3% had NDCC. Regarding the criterion validity, NDCC correlated with CDR (r = 0.68, p < 0.0001), with IQCODE (r = 0.47; p < 0.0001) and had a statistically significant association with the neuropathological diagnosis (p < 0.0001). The main neuropathological predictors of NDCC were: Vascular Dementia (OR = 18.00; p < 0.0001), Mixed Dementia (OR = 9.58; p < 0.0001), Frontotemporal Lobar Degeneration (OR = 9.58; p = 0.004) and Alzheimer's Disease (OR = 9.00; p < 0.0001). The best predictive capacity was for the diagnosis of Vascular Dementia (AUC = 0.717, 95% CI 0.629-0.806). NDCC increases the chance to have neuropathological lesions by 7,16. Conclusion: In general, the NDCC presented good evidence of criterion validity in relation to the gold standard diagnosis of the main neurodegenerative diseases. However, it still lacks refinement and a better exploration of its defining characteristics in order to increase its diagnostic capacity in relation to others neurodegenerative conditions. The related factors presented in the NDCC approved by NANDA-I is in need of a revision, based on the results of the present study.
 
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Publishing Date
2018-05-04
 
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