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

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

doi:10.1186/s13054-018-2037-6

Abstract

BackgroundAccurate 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.MethodsThis 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.ResultsIn 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.ConclusionsWhile 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 registrationClinicalTrials.gov, NCT02518646. Registered on 21 July 2015.

Highlights

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
Patients were excluded if they had delirium at the time of ICU admission, were discharged from the ICU within 6 h, or were unable to be reliably assessed for delirium [9,10,11]
All centres were included in the primary analysis. This large, multinational prospective cohort study provides insight into the comparative performance of two available ICU delirium prediction models

Summary

Introduction

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. Delirium, defined as acute brain dysfunction featured by disturbances of attention, awareness, and cognition with a fluctuating course caused by an underlying medical condition [1], occurs frequently in the intensive care unit (ICU), is associated with impaired patient outcome, and substantially increases healthcare costs [2, 3]. Given these deleterious consequences, delirium prevention is crucial. Involvement of family in patient care in the ICU is stimulated by many ICU societies worldwide [6, 7] and might even increase the prevalence of interventions for delirium prevention and treatment in the ICU [8]

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