Delirium prediction in the intensive care unit: comparison of two delirium prediction models

Annelies Wassenaar; Lisette Schoonhoven; John W Devlin; Frank M P van Haren; Arjen J C Slooter; Philippe G Jorens; Mathieu van der Jagt; Koen S Simons; Ingrid Egerod; Lisa D Burry; Albertus Beishuizen; Joaquim Matos; A Rogier T Donders; Peter Pickkers; Mark van den Boogaard

doi:10.1186/s13054-018-2037-6

Delirium prediction in the intensive care unit: comparison of two delirium prediction models

Annelies Wassenaar, Lisette Schoonhoven, John W Devlin, Frank M P van Haren, Arjen J C Slooter, Philippe G Jorens, Mathieu van der Jagt, Koen S Simons, Ingrid Egerod, Lisa D Burry, Albertus Beishuizen, Joaquim Matos, A Rogier T Donders, Peter Pickkers, Mark van den Boogaard

47 Citations (Scopus)

Abstract

BACKGROUND: Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation.

METHODS: This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h.

RESULTS: In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71-0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66-0.71)) (z score of - 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible.

CONCLUSIONS: While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT02518646 . Registered on 21 July 2015.

Original language	English
Journal	Critical care (London, England)
Volume	22
Issue number	1
Pages (from-to)	114
ISSN	1466-609X
DOIs	https://doi.org/10.1186/s13054-018-2037-6
Publication status	Published - 5 May 2018

Keywords

APACHE
Adult
Aged
Area Under Curve
Australia
Belgium
Canada
Cohort Studies
Decision Support Techniques
Delirium/diagnosis
Denmark
Female
Humans
Intensive Care Units/organization & administration
Male
Middle Aged
Netherlands
Portugal
Prospective Studies
ROC Curve
United States

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10.1186/s13054-018-2037-6

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Wassenaar, A., Schoonhoven, L., Devlin, J. W., van Haren, F. M. P., Slooter, A. J. C., Jorens, P. G., van der Jagt, M., Simons, K. S., Egerod, I., Burry, L. D., Beishuizen, A., Matos, J., Donders, A. R. T., Pickkers, P., & van den Boogaard, M. (2018). Delirium prediction in the intensive care unit: comparison of two delirium prediction models. Critical care (London, England), 22(1), 114. https://doi.org/10.1186/s13054-018-2037-6

Wassenaar, A, Schoonhoven, L, Devlin, JW, van Haren, FMP, Slooter, AJC, Jorens, PG, van der Jagt, M, Simons, KS, Egerod, I, Burry, LD, Beishuizen, A, Matos, J, Donders, ART, Pickkers, P & van den Boogaard, M 2018, 'Delirium prediction in the intensive care unit: comparison of two delirium prediction models', Critical care (London, England), vol. 22, no. 1, pp. 114. https://doi.org/10.1186/s13054-018-2037-6

@article{f34a9d21528247a28223957e6752284c,

title = "Delirium prediction in the intensive care unit: comparison of two delirium prediction models",

abstract = "BACKGROUND: Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation.METHODS: This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h.RESULTS: In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71-0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66-0.71)) (z score of - 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible.CONCLUSIONS: While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02518646 . Registered on 21 July 2015.",

keywords = "APACHE, Adult, Aged, Area Under Curve, Australia, Belgium, Canada, Cohort Studies, Decision Support Techniques, Delirium/diagnosis, Denmark, Female, Humans, Intensive Care Units/organization & administration, Male, Middle Aged, Netherlands, Portugal, Prospective Studies, ROC Curve, United States",

author = "Annelies Wassenaar and Lisette Schoonhoven and Devlin, {John W} and {van Haren}, {Frank M P} and Slooter, {Arjen J C} and Jorens, {Philippe G} and {van der Jagt}, Mathieu and Simons, {Koen S} and Ingrid Egerod and Burry, {Lisa D} and Albertus Beishuizen and Joaquim Matos and Donders, {A Rogier T} and Peter Pickkers and {van den Boogaard}, Mark",

year = "2018",

month = may,

day = "5",

doi = "10.1186/s13054-018-2037-6",

language = "English",

volume = "22",

pages = "114",

journal = "Critical care (London, England)",

issn = "1466-609X",

publisher = "BioMed Central Ltd",

number = "1",

}

TY - JOUR

T1 - Delirium prediction in the intensive care unit

T2 - comparison of two delirium prediction models

AU - Wassenaar, Annelies

AU - Schoonhoven, Lisette

AU - Devlin, John W

AU - van Haren, Frank M P

AU - Slooter, Arjen J C

AU - Jorens, Philippe G

AU - van der Jagt, Mathieu

AU - Simons, Koen S

AU - Egerod, Ingrid

AU - Burry, Lisa D

AU - Beishuizen, Albertus

AU - Matos, Joaquim

AU - Donders, A Rogier T

AU - Pickkers, Peter

AU - van den Boogaard, Mark

PY - 2018/5/5

Y1 - 2018/5/5

N2 - BACKGROUND: Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation.METHODS: This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h.RESULTS: In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71-0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66-0.71)) (z score of - 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible.CONCLUSIONS: While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02518646 . Registered on 21 July 2015.

AB - BACKGROUND: Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation.METHODS: This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h.RESULTS: In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71-0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66-0.71)) (z score of - 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible.CONCLUSIONS: While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02518646 . Registered on 21 July 2015.

KW - APACHE

KW - Adult

KW - Aged

KW - Area Under Curve

KW - Australia

KW - Belgium

KW - Canada

KW - Cohort Studies

KW - Decision Support Techniques

KW - Delirium/diagnosis

KW - Denmark

KW - Female

KW - Humans

KW - Intensive Care Units/organization & administration

KW - Male

KW - Middle Aged

KW - Netherlands

KW - Portugal

KW - Prospective Studies

KW - ROC Curve

KW - United States

U2 - 10.1186/s13054-018-2037-6

DO - 10.1186/s13054-018-2037-6

M3 - Journal article

C2 - 29728150

SN - 1466-609X

VL - 22

SP - 114

JO - Critical care (London, England)

JF - Critical care (London, England)

IS - 1

ER -

Delirium prediction in the intensive care unit: comparison of two delirium prediction models

Abstract

Keywords

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