Early prediction of delirium
Published Date: 19th July 2016
Publication Authors: Jones C
INTRODUCTION
Delirium incidence in Intensive Care Unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention. We developed and validated an early ICU delirium prediction model.
OBJECTIVE
To develop and validate a model based on data available at ICU admission to predict delirium for the entire ICU length of stay and to evaluate its performance related to the moment delirium occurs.
METHODS
Prospective cohort study in thirteen ICUs from seven countries. Data of eighteen candidate delirium predictors were collected at ICU admission. Delirium was assessed using the confusion assessment method-ICU (CAM-ICU). Multiple logistic regression analysis was used to develop the early prediction (E-PRE-DELIRIC) model on data of the first two-thirds and validated on data of the last one-third of the patients from every participating hospital. The performance of the model was determined using the area under the receiver operating characteristic curve (AUROC) and calibration was assessed graphically.
RESULTS
In total 2,914 patients were included. The E-PRE-DELIRIC model consists of nine predictors assessed at ICU admission: age, history of cognitive impairment, history of alcohol abuse, urea level, admission category, urgent admission, mean arterial blood pressure, use of corticosteroids, and respiratory failure (table). The AUROC to predict delirium for the complete ICU length of stay was 0.75 (95 %CI 0.73-0.77) in the development and validation data set (figure). The model was well calibrated. Delirium that occurred later during ICU admission could be predicted more accurately, AUROC increased from 0.70 (95 %CI 0.67-0.74,<2 days) to 0.81 (95 %CI 0.78-0.84,>6 days).
CONCLUSIONS
Using the E-PRE-DELIRIC model patients' risk for ICU delirium can be predicted at admission, allowing early delirium preventive interventions in patients with a high delirium risk.
Wassenaar, A; Jones, C et al. (2014). Early prediction of delirium in ICU patients (E-PRE-DELIRIC): Multinational development and validation of an early delirium prediction model for intensive care patients . Intensive Care Medicine. 40 (Supplement 1), S291-92
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