Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of externally derived risk scores

Abstract

Background: reliable delirium risk stratification will aid recognition, anticipation and prevention and will facilitate targeting of resources in clinical practice as well as identification of at-risk patients for research. Delirium risk scores have been derived for acute medicine, but none has been prospectively validated in external cohorts. We therefore aimed to determine the reliability of externally derived risk scores in a consecutive cohort of older acute medicine patients.Methods: consecutive patients aged ≥65 over two 8-week periods (2010, 2012) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The reliability of existing delirium risk scores derived in acute medicine cohorts and simplified for use in routine clinical practice (USA, n = 2; Spain, n = 1; Indonesia, n = 1) was determined by the area under the receiver operating characteristic curve (AUC). Delirium was defined as prevalent (on admission), incident (occurring during admission) and any (prevalent + incident) delirium.Results: among 308 consecutive patients aged ≥65 (mean age/SD = 81/8 years, 164 (54%) female), existing delirium risk scores had AUCs for delirium similar to those reported in their original internal validations ranging from 0.69 to 0.76 for any delirium and 0.73 to 0.83 for incident delirium. All scores performed better than chance but no one score was clearly superior.Conclusions: externally derived delirium risk scores performed well in our independent acute medicine population with reliability unaffected by simplification and might therefore facilitate targeting of multicomponent interventions in routine clinical practice.

Renal function and delirium in older fracture patients: different information from different formulas?

“…Moreover, we did not separate between prevalent and incident cases, as the aim of the study was not to build a predictive score for delirium incidence, but to assess the association between renal function on admission and delirium, whenever occurred, in order to increase the awareness of this association in older fracture patients. This approach is consistent with a previous study by Pendlebury et al [51] investigating the detection of "any delirium" (both incident and prevalent cases). Future studies could better analyze the temporal framework of this association.…”

Nursing assessment as an effective tool for the identification of delirium risk in older in‐patients: A case–control study

“…Although we only considered people aged 65 years or more, we found statistically significant differences in age between the two groups. The studies show that vulnerability increases with age, but when a minimum age for participation is a selection criterion (as in our case), the associative strength of this variable in relation to delirium may be less (Newman et al, 2015;Pendlebury et al, 2016). As in other studies, age was also an independent predictor of delirium in our multivariate model.…”

Models for Predicting Incident Delirium in Hospitalized Older Adults: A Systematic Review

“…A total of 20 risk factors were identified (Table 4). [7][8][9][10][11][12][13][14][15][16][17][18] The quality of the studies ranged from 4 to 8 ( Table 5). The most common issues leading to lower quality scores were lack of documentation of follow-up and blinding.…”