Abstract
Delirium prevalence is high in the ICU but differs substantially based on underlying critical illness, specific vulnerabilities, and risk factors that are present. Given the deleterious effects of delirium in the critically ill and the ever-increasing number of preventative interventions that can be delivered to patients to reduce its occurrence, ICU delirium prediction models are indispensable tools for clinicians.
This chapter highlights the importance of delirium prediction in the ICU and the key steps when interpreting prediction model development, validation, and calibration efforts. Through a detailed review of existing delirium prediction models, particularly on how they should be interpreted and the potential limitations associated with their use, ICU clinicians and researchers will gain a better understanding on how to apply these models in practice and to evaluate their impact and areas for future research in this field.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Rood P, Huisman-de Waal G, Vermeulen H, Schoonhoven L, Pickkers P, van den Boogaard M. Effect of organisational factors on the variation in incidence of delirium in intensive care unit patients: a systematic review and meta-regression analysis. Aust Crit Care. 2018;31:180.
Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27(12):1892–900.
Devlin JW, Skrobik Y, Gélinas DMN, Slooter AJ, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the intensive care unit. Crit Care Med. 2018;46:e825–e73.
van den Boogaard M, Schoonhoven L, van Achterberg T, van der Hoeven JG, Pickkers P. Haloperidol prophylaxis in critically ill patients with a high risk for delirium. Crit Care. 2013;17(1):R9.
Mistraletti G, Pelosi P, Mantovani ES, Berardino M, Gregoretti C. Delirium: clinical approach and prevention. Best Pract Res Clin Anaesthesiol. 2012;26(3):311–26.
Steyerberg EW. In: Gail M, Krickeberg K, Samet J, Tsiatis A, Wong W, editors. Clinical prediction models; a practical appraoch to development, validation, ad updating. Rotterdam: Springer Science+Business Media, LCC; 2009.
Altman DG, Royston P. What do we mean by validating a prognostic model? Stat Med. 2000;19(4):453–73.
van den Boogaard M, Pickkers P, Slooter AJ, Kuiper MA, Spronk PE, van der Voort PH, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.
Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009;13(3):R77.
Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40–7.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.
Ely EW, Girard TD, Shintani AK, Jackson JC, Gordon SM, Thomason JW, et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med. 2007;35(1):112–7.
Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275(11):852–7.
van den Boogaard M, Schoonhoven L, Maseda E, Plowright C, Jones C, Luetz A, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40(3):361–9.
Wassenaar A, Schoonhoven L, Devlin JW, van Haren FMP, Slooter AJC, Jorens PG, et al. External validation of two models to predict delirium in critically ill adults using either the confusion assessment method-ICU or the intensive care delirium screening checklist for delirium assessment. Crit Care Med. 2019. https://doi.org/10.1097/CCM.0000000000003911.
Wassenaar A, van den Boogaard M, van Achterberg T, Slooter AJ, Kuiper MA, Hoogendoorn ME, et al. Multinational development and validation of an early prediction model for delirium in ICU patients. Intensive Care Med. 2015;41(6):1048–56.
Marra A, Pandharipande PP, Shotwell MS, Chandrasekhar R, Girard TD, Shintani AK, et al. Acute brain dysfunction: development and validation of a daily prediction model. Chest. 2018.
Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R, Stori S, et al. Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg. 2013;257(6):1160–7.
Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for intensive care delirium: a systematic review. Intensive Crit Care Nurs: Off J British Assoc Crit Care Nurs. 2008;24(2):98–107.
Azuma K, Mishima S, Shimoyama K, Ishii Y, Ueda Y, Sakurai M, et al. Validation of the prediction of delirium for intensive care model to predict subsyndromal delirium. Acute Med Surg. 2019;6(1):54–9.
Spronk PE, Riekerk B, Hofhuis J, Rommes JH. Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med. 2009;35(7):1276–80.
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(7):775–83.
van den Boogaard M, Slooter AJC, Bruggemann RJM, Schoonhoven L, Beishuizen A, Vermeijden JW, et al. Effect of haloperidol on survival among critically ill adults with a high risk of delirium: the REDUCE randomized clinical trial. JAMA. 2018;319(7):680–90.
Wassenaar A, Rood P, Schoonhoven L, Teerenstra S, Zegers M, Pickkers P, et al. The impact of nUrsiNg DEliRium Preventive INnterventions in the Intensive Care Unit (UNDERPIN-ICU): a study protocol for a multi-centre, stepped wedge randomized controlled trial. Int J Nurs Stud. 2017;68:1–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
van den Boogaard, M., Devlin, J.W. (2020). Prediction Models for Delirium in Critically Ill Adults. In: Hughes, C., Pandharipande, P., Ely, E. (eds) Delirium. Springer, Cham. https://doi.org/10.1007/978-3-030-25751-4_5
Download citation
DOI: https://doi.org/10.1007/978-3-030-25751-4_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-25750-7
Online ISBN: 978-3-030-25751-4
eBook Packages: MedicineMedicine (R0)