Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study
- 1.9k Downloads
Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients.
A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 h after ICU admission. The confusion assessment method for the intensive care unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data.
A total of 2,852 adult ICU patients were screened of which 1,824 (64 %) were eligible for the study. Main reasons for exclusion were length of stay <1 day (19.1 %) and sustained coma (4.1 %). CAM-ICU compliance was mean (SD) 82 ± 16 % and inter-rater reliability 0.87 ± 0.17. The median delirium incidence was 22.5 % (IQR 12.8–36.6 %). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the eight participating centers remained good: 0.77 (95 % CI 0.74–0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved re-calibration of the PRE-DELIRIC model.
In this multinational study, we recalibrated the PRE-DELIRIC model. Despite differences in the incidence of predictors between the centers in the different countries, the performance of the PRE-DELIRIC-model remained good. Following validation of the PRE-DELIRIC model, it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.
KeywordsDelirium Prediction model Recalibration Critical care
The authors would like to thank Amanda McCairn and Sue Dowling (research nurses, Whiston Hospital), Anna Schandl (PhD student, Karolinska University Hospital, Stockholm) Lena James and Rod Hurford (Princess Alexandra Hospital, Brisbane, Australia) Walter Verbrugghe, Petra Vertongen (MD/staff member and data management, Antwerp University Hospital, Belgium) for their help in collecting the patient data.
Conflicts of interest
The authors declare that they have no competing interests.
- 1.Association AP (2013) Diagnostic and statistical manual of mental disorders (DSM-V). American Psychiatric Publishing, ArlingtonGoogle Scholar
- 8.van Eijk MM, van den Boogaard M, van Marum RJ, Benner P, Eikelenboom P, Honing ML, van der HB, Horn J, Izaks GJ, Kalf A, Karakus A, Klijn IA, Kuiper MA, De Leeuw FE, De MT, van der Mast RC, Osse RJ, de Rooij SE, Spronk PE, van dV, Van Gool WA, Slooter AJ (2011) Routine use of the confusion assessment method for the intensive care unit: a multicenter study. Am J Respir Crit Care Med 184:340–344PubMedCrossRefGoogle Scholar
- 10.Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710PubMedCrossRefGoogle Scholar
- 12.van den Boogaard M, Pickkers P, Schoonhoven L (2010) Assessment of delirium in ICU patients; a literature review. Neth J Crit Care 14:10–15Google Scholar
- 13.Gusmao-Flores D, Figueira Salluh JI, Chalhub RA, Quarantini LC (2012) The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care 16:R115PubMedCentralPubMedCrossRefGoogle Scholar
- 19.Wang W, Li HL, Wang DX, Zhu X, Li SL, Yao GQ, Chen KS, Gu XE, Zhu SN (2012) Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 40:1–9Google Scholar
- 20.van den Boogaard M, Pickkers P, Slooter AJ, Kuiper MA, Spronk PE, van der Voort PHJ, van der Hoeven JG, Donders R, van AT, Schoonhoven L (2012) Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICU patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ 344:e420PubMedCentralPubMedCrossRefGoogle Scholar
- 23.Harrell Jr FE (2001) Regression modeling strategies. With applications to linear models, logistic regression, and survival analysis. Springer, New YorkGoogle Scholar
- 27.Team RDC (2009) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 28.Harrell FE, Jr (2012) Hmisc: Harrell Miscellaneous (R package version 3.9–3). Contributions from many other users. Available at http://CRAN.R-project.org/package=Hmisc
- 34.Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW (2007) Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298:2644–2653PubMedCrossRefGoogle Scholar
- 35.Hughes CG, McGrane S, Pandharipande PP (2012) Sedation in the intensive care setting. Clin Pharmacol: Adv Appl 4:53–63Google Scholar
- 36.Riker R, Shehabi Y, Wisemandle W, Rocha M (2012) Relationship between delirium iIncidence assessed with CAM-ICU and level of sedation assessed by RASS in adult ICU Patients. Crit Care Med. doi: 10.1097/01.ccm.0000425304.19686.5d
- 39.Devlin JW, Fraser GL, Joffe AM, Riker RR, Skrobik Y (2013) The accurate recognition of delirium in the ICU: the emperor’s new clothes? Intensive Care Med 39:2196–2199Google Scholar
- 40.Vasilevskis EE, Morandi A, Boehm L, Pandharipande PP, Girard TD, Jackson JC, Thompson JL, Shintani A, Gordon SM, Pun BT, Wesley EE (2011) Delirium and sedation recognition using validated instruments: reliability of bedside intensive care unit nursing assessments from 2007 to 2010. J Am Geriatr Soc 59(Suppl 2):S249–S255PubMedCentralPubMedCrossRefGoogle Scholar