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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

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

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

Published in: Critical Care | Issue 1/2018

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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.
Appendix
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Metadata
Title
Delirium prediction in the intensive care unit: comparison of two delirium prediction models
Authors
Annelies Wassenaar
Lisette Schoonhoven
John W. Devlin
Frank M. P. van Haren
Arjen J. C. Slooter
Philippe G. Jorens
Mathieu van der Jagt
Koen S. Simons
Ingrid Egerod
Lisa D. Burry
Albertus Beishuizen
Joaquim Matos
A. Rogier T. Donders
Peter Pickkers
Mark van den Boogaard
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2037-6

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