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Multicenter Study
. 2024 Sep;32(9):1093-1104.
doi: 10.1016/j.jagp.2023.12.005. Epub 2023 Dec 9.

DeltaScan for the Assessment of Acute Encephalopathy and Delirium in ICU and non-ICU Patients, a Prospective Cross-Sectional Multicenter Validation Study

Fienke L Ditzel  1 , Suzanne C A Hut  2 , Mark van den Boogaard  3 , Michel Boonstra  2 , Frans S S Leijten  4 , Evert-Jan Wils  5 , Tim van Nesselrooij  6 , Marjan Kromkamp  6 , Paul J T Rood  7 , Christian Röder  6 , Paul F Bouvy  8 , Michiel Coesmans  8 , Robert Jan Osse  8 , Monica Pop-Purceleanu  9 , Edwin van Dellen  10 , Jaap W M Krulder  11 , Koen Milisen  12 , Richard Faaij  13 , Ariël M Vondeling  13 , Ad M Kamper  14 , Barbara C van Munster  15 , Annemarieke de Jonghe  16 , Marian A M Winters  14 , Jeanette van der Ploeg  14 , Sanneke van der Zwaag  14 , Dineke H L Koek  17 , Clara A C Drenth-van Maanen  17 , Albertus Beishuizen  18 , Deirdre M van den Bos  2 , Wiepke Cahn  6 , Ewoud Schuit  19 , Arjen J C Slooter  20
Affiliations
Multicenter Study

DeltaScan for the Assessment of Acute Encephalopathy and Delirium in ICU and non-ICU Patients, a Prospective Cross-Sectional Multicenter Validation Study

Fienke L Ditzel et al. Am J Geriatr Psychiatry. 2024 Sep.

Abstract

Objectives: To measure the diagnostic accuracy of DeltaScan: a portable real-time brain state monitor for identifying delirium, a manifestation of acute encephalopathy (AE) detectable by polymorphic delta activity (PDA) in single-channel electroencephalograms (EEGs).

Design: Prospective cross-sectional study.

Setting: Six Intensive Care Units (ICU's) and 17 non-ICU departments, including a psychiatric department across 10 Dutch hospitals.

Participants: 494 patients, median age 75 (IQR:64-87), 53% male, 46% in ICUs, 29% delirious.

Measurements: DeltaScan recorded 4-minute EEGs, using an algorithm to select the first 96 seconds of artifact-free data for PDA detection. This algorithm was trained and calibrated on two independent datasets.

Methods: Initial validation of the algorithm for AE involved comparing its output with an expert EEG panel's visual inspection. The primary objective was to assess DeltaScan's accuracy in identifying delirium against a delirium expert panel's consensus.

Results: DeltaScan had a 99% success rate, rejecting 6 of the 494 EEG's due to artifacts. Performance showed and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.86 (95% CI: 0.83-0.90) for AE (sensitivity: 0.75, 95%CI=0.68-0.81, specificity: 0.87 95%CI=0.83-0.91. The AUC was 0.71 for delirium (95%CI=0.66-0.75, sensitivity: 0.61 95%CI=0.52-0.69, specificity: 72, 95%CI=0.67-0.77). Our validation aim was an NPV for delirium above 0.80 which proved to be 0.82 (95%CI: 0.77-0.86). Among 84 non-delirious psychiatric patients, DeltaScan differentiated delirium from other disorders with a 94% (95%CI: 87-98%) specificity.

Conclusions: DeltaScan can diagnose AE at bedside and shows a clear relationship with clinical delirium. Further research is required to explore its role in predicting delirium-related outcomes.

Keywords: Acute encephalopathy; Delirium; EEG; Polymorphic delta activity.

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