Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU

Tang, Elaine; Laverty, Mairi; Weir, Alexander; Wilson, Elizabeth; Walsh, Timothy; Allerhand, Mike; Parks, S.; MacLullich, Alasdair M.J.; Tieges, Zoë

doi:10.1016/j.jcrc.2018.08.019

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…The DelApp is a computerized, objective test of arousal and attention that is implemented on a smartphone and is for use in both the general population and ICU patients. Case-control studies show a high sensitivity and a moderate-to-high specificity of DelApp in the detection of delirium 235,236 .…”

Section: Delirium Assessment In the Icumentioning

confidence: 99%

Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

590

602

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Section: Delirium Assessment In the Icumentioning

confidence: 99%

Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

590

602

View full text Add to dashboard Cite

“…Only 10 papers were low risk in blinding of outcome measures, 5,20,44,46,48,51,55,66,67,70 with most papers presenting unclear risk due to a lack of clarity around blinding details. In terms of incomplete outcome data, 12 papers had high risk due to an absence of a published protocol 5,29,30,43,45,46,48,55,61,65,67,68 . The highest RoB was found regarding confounding variables; only five papers 29,39,45,54,57,61 had low RoB in confounding variables, with the remaining papers presenting a high risk.…”

Section: Resultsmentioning

confidence: 99%

“…Only four assessments used were delirium‐specific: the DRS‐R98, 18 the Cognitive Test for Delirium (CTD), 28 The Edinburgh Delirium Test Box (EDTB) 29 and the DelApp, 30 with less than half of the included studies (14 studies) using these tools. Included studies using the DRS‐R98 reported results for its constituent 13 symptom domains for example, hallucinations, delusions, motor agitation, etc., in addition to the overall DRS‐R98 score.…”

Section: Resultsmentioning

confidence: 99%

“…In terms of incomplete outcome data, 12 papers had high risk due to an absence of a published protocol. 5,29,30,43,45,46,48,55,61,65,67,68 The highest RoB was found regarding confounding variables; only five papers 29,39,45,54,57,61 Despite most studies reporting an improvement in general cognition, two studies investigating change in general cognition found no improvement in reported deficits over time. 47,48 This may be due to Lowery et al 47 reporting on a small sample of patients with delirium in a non-representative setting (elective orthopaedic ward).…”

Section: Risk Of Biasmentioning

confidence: 97%

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A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

McCartney

Noble

MacLullich

et al. 2023

Int J Geriat Psychiatry

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Objectives Assessing for recovery in delirium is essential in guiding ongoing investigation and treatment. Yet, there is little scrutiny and no research or clinical consensus on how recovery should be measured. We reviewed studies which used tests of neuropsychological domains and functional ability to track recovery of delirium longitudinally in acute hospital settings. Methods/Design We systematically searched databases (MEDLINE, PsycInfo, CINAHL, Embase, http://ClinicalTrials.gov, Cochrane Central Register of Controlled Trials), from inception to October 14th, 2022. Inclusion criteria were: adult acute hospital patients (≥18 years) diagnosed with delirium by a validated tool; 1+ repeat assessment using an assessment tool measuring domains of delirium/functional recovery ≤7 days from baseline. Two reviewers independently screened articles, performed data extraction, and assessed risk of bias. A narrative data synthesis was completed. Results From 6533 screened citations, we included 39 papers (reporting 32 studies), with 2370 participants with delirium. Studies reported 21 tools with an average of four repeat assessments including baseline (range 2–10 assessments within ≤7 days), measuring 15 specific domains. General cognition, functional ability, arousal, attention and psychotic features were most commonly assessed for longitudinal change. Risk of bias was moderate to high for most studies. Conclusions There was no standard approach for tracking change in specific domains of delirium. The methodological heterogeneity of studies was too high to draw firm conclusions on the effectiveness of assessment tools to measure delirium recovery. This highlights the need for standardised methods for assessing recovery from delirium.

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“…Future studies are needed to evaluate the utility of OSLA in different populations (eg, palliative care, emergency departments) and to assess the prognostic value of higher OSLA scores for unfavourable outcomes in prospective cohort studies. A recent study provided preliminary support for the utility of the OSLA as a tool for detailed measurement of level of arousal in ICU patients, 27 though the OSLA itself has yet to be formally validated in this population.…”

Section: Discussionmentioning

confidence: 99%

The Observational Scale of Level of Arousal: A brief tool for assessing and monitoring level of arousal in patients with delirium outside the ICU

Hall

Stíobhairt

Allerhand

et al. 2020

Int J Geriat Psychiatry

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Altered level of arousal, encompassing drowsiness and hypervigilance, affects at least 10% of acutely unwell patients. Existing scales provide limited coverage of milder changes in level of arousal. We devised the Observational Scale of Level of Arousal (OSLA) to enable more detailed arousal assessment. Here, we provide a preliminary case-control study of performance of the OSLA in assessing abnormal level of arousal associated with delirium outside the ICU. Methods: Hip fracture patients (N = 108, median age = 82 years) were assessed for delirium pre-and post-operatively using the Confusion Assessment Method and the Delirium Rating Scale-Revised-98. The OSLA has four graded items assessing eye opening, eye contact, posture, and movement (score range 0 [normal arousal]-15). We assessed the psychometric and diagnostic characteristics of the OSLA. Adjusted linear mixed effects models were used to explore responsiveness of the OSLA to within-patient change in delirium status. Results: A total of 44 patients (40.7%) were diagnosed with delirium. OSLA scores were higher in delirium (pooled median = 3, InterQuartile Range [IQR] = 2-5) compared to no delirium (pooled median = 1, IQR = 1-2; P-values <.05 to <.001). The Area under the Receiver Operating Characteristic curve was 0.82 (95% Confidence Interval (CI) = 0.77-0.86). OSLA scores were responsive to change in delirium status (ß = −3.09. SE = 1.41, P < .03). Conclusions: This study provides preliminary evidence supporting use of the OSLA as an instrument for identifying abnormal level of arousal associated with delirium and monitoring this longitudinally. Further validation in larger cohorts with blinded raters is required.

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Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU

Abstract: DelApp-ICU shows promise for assessing inattention and delirium in ICU patients, including longitudinally monitoring deficits and providing a metric of delirium severity.

Cited by 8 publications

References 32 publications

Delirium

Delirium

A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

The Observational Scale of Level of Arousal: A brief tool for assessing and monitoring level of arousal in patients with delirium outside the ICU

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