REcognizing DElirium in geriatric Emergency Medicine: The REDEEM risk stratification score

Abstract

Objective:The objective was to derive a risk score that uses variables available early during the emergency department (ED) encounter to identify high-risk geriatric patients who may benefit from delirium screening. Methods:This was an observational study of older adults age ≥ 75 years who presented to an academic ED and who were screened for delirium during their ED visit.Variable selection from candidate predictors was performed through a LASSOpenalized logistic regression. A risk score was derived from the final prediction model, and predictive accuracy characteristics were calculated with 95% confidence intervals (CIs).Results: From the 967 eligible ED visits, delirium was detected in 107 (11.1%). The area under the curve for the REcognizing DElirium in Emergency Medicine (REDEEM) score was 0.901 (95% CI = 0.864-0.938). The REEDEM risk score included 10 different variables (seven based on triage information and three obtained during early history taking) with a score ranging from -3 to 66. Using an optimal cutoff of ≥11, we found a sensitivity of 84.1% (90 of 107 ED delirium patients, 95% CI = 75.5%-90.2%) and a specificity of 86.6% (745 of 860 non-ED delirium patients, 95% CI = 84.1%-88.8%). A lower cutoff of ≥5 was found to minimize false negatives with an improved sensitivity at 91.6% (98 of 107 ED delirium patients, 95% CI = 84.2%-95.8%). Conclusion:A risk stratification score was derived with the potential to augment delirium recognition in geriatric ED patients. This has the potential to assist on deliriumtargeted screening of high-risk patients in the ED. Validation of REDEEM, however, is needed prior to implementation.

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

“…Some researchers have proposed multiparametric tools for predicting delirium onset in hospital patients [ 4 , 5 ]. Despite their good performance, these tools require the collection of several anamnestic, physiologic and laboratory parameters, and are not always centered on the characteristics of geriatric patients.…”