Automated EEG-Based Brainwave Analysis for the Detection of Postoperative Delirium Does Not Result in a Shorter Length of Stay in Geriatric Hip Fracture Patients: A Multicentre Randomized Controlled Trial

Abstract

Introduction: Delirium in postoperative geriatric hip fracture patients is a serious and often preventable condition. If detected in time, it can be treated, but a delay in the diagnosis and initiation of treatment impairs outcomes. A novel approach to detect delirium is to use point-of-care electro-encephalogram (EEG) recording with automated analysis. In this study, the authors investigated whether screening for delirium with EEG recording and automated analysis resulted in reduced length of stay after surgery and superior screening performance in comparison to the Delirium Observation Screening Scale (DOS). Methods: This randomized control trial was conducted at two geriatric trauma centres in the Netherlands. Patients were eligible for inclusion if they were aged 70 years or above, were admitted to the geriatric trauma unit and undergoing surgery for a hip fracture. Patients were randomized to either the intervention (EEG-based brainwave analysis) or control group (DOSS screening tool). Participants were screened for delirium twice a day during three consecutive days starting at day 0 of the surgery, with the first measurement before the surgery. The primary outcome was length of stay. In addition, the screening performance for both automated EEG-based brainwave analysis and DOS was determined. Results: A total of 388 patients were included (189 per arm). There were no differences between groups in terms of median hospital length of stay (DOS 7 days (IQR 5.75-9) vs. EEG-based brainwave analysis 7 days (IQR 5-9); p = 0.867). The performance of EEG-based brainwave analysis was considerably lower than that of the DOSS in terms of discrimination between patients with and without postoperative delirium. Conclusions: Screening for postoperative delirium in geriatric hip fracture patients using automated EEG-based brainwave analysis did not result in a shorter length of stay. Additionally, the results of this study show no clear advantage in terms of the screening performance of EEG-based brainwave analysis over the current standard of care for geriatric patients with a hip fracture.

Keywords: Delirium Observation Screening Scale; DeltaScan; EEG; RCT; geriatric; hip fracture; postoperative delirium; trauma.

Figure A1

Mean length of stay for hip fracture patients at St. Antonius Ziekenhuis.

Figure A2

Mean Log10 transformation length of stay for hip fracture patients at St. Antonius Ziekenhuis.

Figure 1

Timeline of study procedures.

Figure 2

Flowchart of patient inclusion.

Figure 3

(a) Boxplots of DeltaScan scores; (b) boxplots of DOS scores. *—outliers.

Figure 3

(a) Boxplots of DeltaScan scores; (b) boxplots of DOS scores. *—outliers.