Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Jun;41(6):1048-56.
doi: 10.1007/s00134-015-3777-2. Epub 2015 Apr 18.

Multinational development and validation of an early prediction model for delirium in ICU patients

A Wassenaar  1 , M van den Boogaard, T van Achterberg, A J C Slooter, M A Kuiper, M E Hoogendoorn, K S Simons, E Maseda, N Pinto, C Jones, A Luetz, A Schandl, W Verbrugghe, L M Aitken, F M P van Haren, A R T Donders, L Schoonhoven, P Pickkers
Affiliations
Multicenter Study

Multinational development and validation of an early prediction model for delirium in ICU patients

A Wassenaar et al. Intensive Care Med. 2015 Jun.

Abstract

Rationale: Delirium incidence in intensive care unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention.

Purpose: To develop and validate a model based on data available at ICU admission to predict delirium development during a patient's complete ICU stay and to determine the predictive value of this model in relation to the time of delirium development.

Methods: Prospective cohort study in 13 ICUs from seven countries. 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 ICU.

Results: In total, 2914 patients were included. Delirium incidence was 23.6%. The E-PRE-DELIRIC model consists of nine predictors assessed at ICU admission: age, history of cognitive impairment, history of alcohol abuse, blood urea nitrogen, admission category, urgent admission, mean arterial blood pressure, use of corticosteroids, and respiratory failure. The area under the receiver operating characteristic curve (AUROC) was 0.76 [95% confidence interval (CI) 0.73-0.77] in the development dataset and 0.75 (95% CI 0.71-0.79) in the validation dataset. The model was well calibrated. AUROC increased from 0.70 (95% CI 0.67-0.74), for delirium that developed <2 days, to 0.81 (95% CI 0.78-0.84), for delirium that developed >6 days.

Conclusion: Patients' delirium risk for the complete ICU length of stay can be predicted at admission using the E-PRE-DELIRIC model, allowing early preventive interventions aimed to reduce incidence and severity of ICU delirium.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Area under the receiver operating characteristic curve (AUROC) of development dataset (AUROC = 0.76)
Fig. 3
Fig. 3
Area under the receiver operating characteristic curve (AUROC) during ICU stay. Error bars 95 % CIs
See this image and copyright information in PMC

Comment in

References

    1. APA . Diagnostic and statistical manual of mental disorders. 5. Washington: American Psychiatric Association (APA) ; 2013.
    1. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007;33:66–73. doi: 10.1007/s00134-006-0399-8. - DOI - PubMed
    1. van den Boogaard M, Schoonhoven L, van der Hoeven JG, van Achterberg T, Pickkers P. Incidence and short-term consequences of delirium in critically ill patients: a prospective observational cohort study. Int J Nurs Stud. 2012;49:775–783. doi: 10.1016/j.ijnurstu.2011.11.016. - DOI - PubMed
    1. Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, Herridge M, Steinberg M, Granton J, Ferguson N, Tanios M, Dodek P, Fowler R, Burns K, Jacka M, Olafson K, Mallick R, Reynolds S, Keenan S, Burry L, Investigators S, the Canadian Critical Care Trials G Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults*. Crit Care Med. 2015;43:557–566. doi: 10.1097/CCM.0000000000000727. - DOI - PubMed
    1. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW, Investigators B-IS. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–1316. doi: 10.1056/NEJMoa1301372. - DOI - PMC - PubMed