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

Critical Care

A. Rogier T. Donders¹  Philippe G. Jorens²  Arjen J. C. Slooter³  Joaquim Matos⁴  Koen S. Simons⁵  Peter Pickkers⁶  Mark van den Boogaard⁶  Annelies Wassenaar⁶  Mathieu van der Jagt⁷  Albertus Beishuizen⁸  Lisette Schoonhoven⁹  Ingrid Egerod^1,10  Frank M. P. van Haren^1,11  Lisa D. Burry^1,12  John W. Devlin^1,13 

[1] Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center;Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp;Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Centre Utrecht;Department of Intensive Care Medicine, Hospital Espírito Santo;Department of Intensive Care Medicine, Jeroen Bosch Ziekenhuis;Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center;Department of Intensive Care, Erasmus Medical Center;Department of Intensive Care, Medisch Spectrum Twente;Faculty of Health Sciences and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton;Intensive Care Unit, Rigshospitalet, University of Copenhagen;Intensive Care Unit, The Canberra Hospital;Leslie Dan Faculty of Pharmacy, University of Toronto;School of Pharmacy, Northeastern University;

关键词: Adult;    Clinical prediction;    Critical illness;    Delirium;    Intensive care unit;   

DOI  :  10.1186/s13054-018-2037-6

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown