Delirium detection by a novel bispectral electroencephalography device in general hospital

Shinozaki, Gen; Chan, Aubrey C.; Sparr, Nicholas A; Zarei, Kasra; Gaul, Lindsey; Heinzman, Jonathan; Robles, Julian; Yuki, Kumi; Chronis, Theodosis; Ando, Timothy; Wong, Terrence; Sabbagh, Sayeh; Weckmann, Michelle T.; Lee, Sangil; Yamada, Thoru; Karam, Matthew D.; Noiseux, Nicolas; Shinozaki, Eri; Cromwell, John W.

doi:10.1111/pcn.12783

Cited by 47 publications

(60 citation statements)

References 32 publications

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“…Due to the objective nature of BSEEG, interrater reliability does not affect it, and it can be more strongly correlated with patient outcomes. Previously, our team showed that BSEEG signals have significant correlation with delirium in general hospital 26 as well as in emergency department 27 settings. Thus, we conducted an expanded study to determine whether BSEEG signals are associated with delirium and whether they predict patient outcomes, including mortality.…”

Section: Objectivementioning

confidence: 99%

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Shinozaki¹,

Bormann²,

Chan³

et al. 2019

J. Clin. Psychiatry

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Background: Delirium is common and dangerous, yet underdetected and undertreated. Current screening questionnaires are subjective and ineffectively implemented in busy hospital workflows. Electroencephalography (EEG) can objectively detect the diffuse slowing characteristic of delirium, but it is not suitable for high-throughput screening due to size, cost, and the expertise required for lead placement and interpretation. This study hypothesized that an efficient and reliable point-of-care EEG device for high-throughput screening could be developed. Methods: This prospective study, which measured bispectral EEG (BSEEG) from elderly inpatients to assess their outcomes, was conducted at the University of Iowa Hospitals and Clinics from January 2016 to October 2017. A BSEEG score was defined based on the distribution of 2,938 EEG recordings from the 428 subjects who were assessed for delirium; primary outcomes measured were hospital length of stay, discharge disposition, and mortality. Results: A total of 274 patients had BSEEG score data available for analysis. Delirium and BSEEG score had a significant association (P < .001). Higher BSEEG scores were significantly correlated with length of stay (P < .001 unadjusted, P = .001 adjusted for age, sex, and Charlson Comorbidity Index [CCI] score) as well as with discharge not to home (P < .01). Hazard ratio for survival controlling for age, sex, CCI score, and delirium status was 1.35 (95% CI,1.04 to 1.76; P = .025). Conclusions: In BSEEG, an efficient and reliable device that provides an objective measurement of delirium status was developed. The BSEEG score is significantly associated with pertinent clinical outcomes of mortality, hospital length of stay, and discharge disposition. The BSEEG score better predicts mortality than does clinical delirium status. This study identified a previously unrecognized subpopulation of patients without clinical features of delirium who are at increased mortality risk.

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Section: Objectivementioning

confidence: 99%

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Shinozaki¹,

Bormann²,

Chan³

et al. 2019

J. Clin. Psychiatry

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“…Classification was achieved by ANFIS [6]. 7. Various parameters such as accuracy, specificity, sensitivity were used to compare the ANFIS classification with other methods such as Naïve-Bayes, Support Vector Machine, Linear Discriminate Analysis, K-Nearest neighbor in table 5.…”

Section: Iiiproposed Methodologymentioning

confidence: 99%

“…Omphaloceleindicates a hole in the fetal abdomen.5.Ultrasonic imaginguses Doppler Effect (above 20 KHz). The amount of frequency shift can be expressed as[7] Where f = shift in frequency of the reflected wave V = velocity of the interface = wave length of the transmitted ultrasoundModes of transmission are a) Pulse ultrasound (1 to 12 KHz) b) continuous Doppler c) Pulsed Doppler (Three cycles of 3MHz are transmitted per pulse at rate of 4 to 12 KHz) a) Range gated Doppler: The types of scan are: -a)A scan b)M scan c)B scan…”

mentioning

confidence: 99%

Detection and Classification of Fetal Abnormalities by Anfis in First Trimester

Rajalakshmi¹,

Sivagamasundari²

2019

IJEAT

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Detection studies of fetal abnormalities are essential particularly in the first trimester. These are important for physicious and patients as abnormality can be corrected in the early stage of growth of fetus. Ultrasound techniques give us good opportunity to known about abnormal his such as Anencephaly, Renal anomalies, Cystic Lymphangioma, Cystic Hygroma, Gastroschisis and Fetal megacystis. Firstly the fetal data has to be processed by proper methods such as those used in digital image processing to generate classification of abnormalities.Secondly comparisons with equivalent methods are to be made. After preprocessing using median filter to remove noise, segmentation is done to give qualitative and quantization analysis. This is followed by feature extraction and feature selection using Particle Swarm optimization .Ultimately classification is done by Adaptive Neural Fuzzy Inference System .Comparison of this method with others is carried out to vindicate the efficacy of the proposed technique. The results show that the classification done by the proposed method scores over that of Naive-byes Supports Vector Machine, Linear Discernment Analysis and K-nearest neighbor methods. The proposed method has advantages in detection and classification of the seven abnormalities taken up.

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“…Study participants were co-enrolled when they were enrolled for a separate, ongoing study of delirium. A more detailed overview of study participants' recruitment process has been described previously (14). Briefly, 92 subjects were recruited for this epigenetics study between November 2017 and October 2018 at the University of Iowa Hospitals and Clinics.…”

Section: Subjects and Sample Collectionmentioning

confidence: 99%

Epigenetics biomarkers of delirium: immune response, inflammatory response and cholinergic synaptic involvement evidenced by genome-wide DNA methylation analysis of delirious inpatients

Saito

Toda

Duncan³

et al. 2019

Preprint

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Background: The authors previously hypothesized the role of epigenetics in pathophysiology of delirium, and tested DNA methylation (DNAm) change among pro-inflammatory cytokines along with aging in blood, glia and neuron. The authors reported that DNAm level of the TNF-alpha decreases along with aging in blood and glia, but not in neuron; however, DNAm differences between delirium cases and non-delirium controls have not been investigated directly. Therefore, in the present study, DNAm differences in blood between delirium patients and controls without delirium were examined.Methods: A case-control study with 92 subjects was conducted. Whole blood samples were collected and genome-wide DNAm was measured by the Infinium HumanMethylationEPIC BeadChip arrays. The correlation between DNAm levels in the TNF-alpha and age, network analysis, and the correlation between age and DNAm age were tested.Results: Only delirium cases showed 3 CpGs sites in the TNF-alpha significantly correlated to age after multiple corrections. A genome-wide significant CpG site near the gene of LDLRAD4 was identified. In addition, network analysis showed several significant pathways with false discovery rate adjusted p-value < 0.05. The top pathway with GO was immune response, and the second top pathway with KEGG was cholinergic synapse. Although there was no statistically significant difference, DNAm age among non-delirium controls showed "slower aging" compared to delirium cases.Conclusions: DNAm differences were shown both at gene and network levels between delirium cases and non-delirium controls. This finding indicates that DNAm status in blood has a potential to be used as epigenetic biomarkers for delirium.

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Delirium detection by a novel bispectral electroencephalography device in general hospital

Cited by 47 publications

References 32 publications

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Detection and Classification of Fetal Abnormalities by Anfis in First Trimester

Epigenetics biomarkers of delirium: immune response, inflammatory response and cholinergic synaptic involvement evidenced by genome-wide DNA methylation analysis of delirious inpatients

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