Abstract
Introduction.Delirium not only compromises patient care, but is also associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction. The PRE-DELIRIC model is a tool used to calculate the risk of the development of delirium. The classification of the patients into groups by risk allows efficient initiation of preventive measures. The goal of this study was to validate the PRE-DELIRIC model using the CAM-ICU (The Confusion Assessment Method for the Intensive Care Unit) method for the diagnosis of delirium.Materials and methods.Patients admitted to the University Hospital of Vilnius during February 2015 were enrolled. Every day, data were collected for APACHE-II and PRE-DELIRIC scores. Out of 167 patients, 38 (23%) were included and screened using the CAM-ICU method within 24 hours of admission to the ICU. We defined patients as having delirium when they had at least one positive CAM-ICU screening or haloperidol administration due to sedation. To validate the PRE-DELIRIC model, we calculated the area under receiver operating characteristic curve.Results.The mean age of the patients was 69.2 ± 17.2 years, 19 (50%) were male, APACHE-II mean score 18.0 ± 7.4 points. Delirium was diagnosed in 22 (58%) of 38 patients. Data used for validation of the PRE-DELIRIC model resulted in an area under the curve of 0.713 (p < 0.05, 95% CI 0.539–0.887); sensitivity and specificity for the patients with 20% risk were, accordingly, 77.3% and 50%; 40% risk – 45.5% and 81.3%, 60% – 36.4%, and 87.5%.Conclusions.The PRE-DELIRIC model predicted delirium in the patients within 24 hours of admission to the ICU. Preventive therapy could be efficiently targeted at high-risk patients if both of the methods are to be implemented.
Highlights
Delirium compromises patient care, but is associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction
According to the Pain, Agitation and Delirium Guidelines [13], non-pharmacological measures such as early mobilization, patient orientation, sleep, and friendly environment are highly recommended for the prevention while the pharmacological approach is still lacking clear evidence
We distinguished three different types of delirium according to psychomotor symptoms indicated by the Richmond Agitation Sedation Scale (RASS) score: hyperactive (RASS > 0, hyperalert, agitated), hypoactive (RASS ≤ 0, hypoalert, lethargic), and mixed (RASS score varied) [17, 18]
Summary
Delirium compromises patient care, but is associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction. The PRE-DELIRIC model is a tool used to calculate the risk of the development of delirium. The goal of this study was to validate the PRE-DELIRIC model using the CAM-ICU (The Confusion Assessment Method for the Intensive Care Unit) method for the diagnosis of delirium. The patients who develop delirium in the ICU have a two-tofour-times increased risk of death both in and out of hospital compared to the patients who do not [4, 5]. Delirium has attracted attention of many researchers worldwide for the past decade. This has led to the development of diagnostic screening tools, prognostic risk models, and effective prevention methods, which are becoming more and more part of routine in the care of critically ill patients
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