Predicting delirium in older non-intensive care unit inpatients: development and validation of the DELIrium risK Tool (DELIKT).

Abstract

Effective delirium prevention could benefit from automatic risk stratification of older inpatients using routinely collected clinical data. Primary aim was to develop and validate a delirium prediction model (DELIKT) suitable for implementation in hospitals. Secondary aim was to select an anticholinergic burden scale as a predictor. We used one cohort for model development and another for validation with electronically available data collected within the first 24h of admission. Included were patients aged ≥ 65, hospitalised ≥ 48h with no stay > 24h in an intensive care unit. Predictors, such as administrative and laboratory variables or an anticholinergic burden scale, were selected using a combination of feature selection filter method and forward/backward selection. The final model was based on logistic regression and the DELIKT was derived from the β-coefficients. We report the following performance measures: area under the curve, sensitivity, specificity and odds ratio. Both cohorts were similar and included over 10,000 patients each (mean age 77.6 ± 7.6years) with 11% experiencing delirium. The model included nine variables: age, medical department, dementia, hemi-/paraplegia, catheterisation, potassium, creatinine, polypharmacy and the anticholinergic burden measured with the Clinician-rated Anticholinergic Scale (CrAS). The external validation yielded an AUC of 0.795. With a cut-off at 20 points in the DELIKT, we received a sensitivity of 79.7%, specificity of 62.3% and an odds ratio of 5.9 (95% CI 5.2,6.7). The DELIKT is a potentially automatic tool with predictors from standard care including the CrAS to identify patients at high risk for delirium.