Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

Abstract

ObjectiveTo describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model.MethodsProspective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).ResultsThe mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90).ConclusionsThe observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.

Delirium

“…In the ICU, the PRE-DELIRIC model 68 , which is based on ten risk factors (age, APACHE-II score, admission group, coma, infection, metabolic acidosis, use of sedatives and morphine, urea concentration and urgent admission) identified within 24 hours of ICU admission, predicted delirium with an area under the receiver operating curve of 0.87 (95% CI 0.85-0.89) in the first 24 hours after admission to the ICU. The PRE-DELIRIC model showed excellent performance in clinical cohorts, including in studies from Lithuania, Scotland and Argentina [69][70][71] .…”

Evaluation of the PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model in intensive care units in Turkey

“…The reported delirium rate in intensive care units has quite a wide range at 10% to 80% and it is important to have a measurement that can easily detect delirium, as it is vital for the condition's follow-up, treatment and care. 19,20,21 Delirium development is affected by many factors and its prediction and prevention will enable decreasing the rate of disorders that could lead to patient mortality and morbidity. 14 Some evidence reports that delirium increases the length of the hospital stay, increases the risk of transmission of hospital infections, and puts the patient at risk of pressure ulcers and injuries.…”

Risk predictive models for delirium in the intensive care unit: a systematic review and meta-analysis

“…In this review, 14 studies reported model development (21)(22)(23)(24)(25)(27)(28)(29)(30)32,36,(39)(40)(41), and 19 studies reported model validation (21)(22)(23)(25)(26)(27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). The method of model development was logistic regression.…”

“…The ROB and clinical applicability were assessed with (21,22,36), and the regression coefficients in the final model were adjusted in another three studies (27,39,41). In terms of predictors and outcomes, the risk of bias was unclear in six articles (26,27,30,(33)(34)(35) because they did not report blind methods in the literature. Details were shown in Appendix 1.…”