Validation of the Prediction of Delirium for Intensive Care model to predict subsyndromal delirium

Abstract

AimSubsyndromal delirium is associated with prolonged intensive care unit stays, and prolonged mechanical ventilation requirements. The Prediction of Delirium for Intensive Care (PRE‐DELIRIC) model can predict delirium. This study was designed to verify if it can also predict development of subsyndromal delirium.MethodsWe undertook a single‐center, retrospective observation study in Japan. We diagnosed subsyndromal delirium based on the Intensive Care Delirium Screening Checklist. We calculated the sensitivity and specificity of the PRE‐DELIRIC model and obtained a diagnostic cut‐off value.ResultsWe evaluated data from 70 patients admitted to the mixed medical intensive care unit of the Tokyo Medical University Hospital (Tokyo, Japan) between May 2015 and February 2017. The prevalence of subsyndromal delirium by Intensive Care Delirium Screening Checklist was 31.4%. The area under the receiver operating characteristic curve was 0.83 of the PRE‐DELIRIC model for subsyndromal delirium. The calculated cut‐off value was 36 points with a sensitivity of 94.3% and specificity of 57.1%. Subsyndromal delirium was associated with a higher incidence of delirium (odds ratio, 8.81; P < 0.01).ConclusionThe PRE‐DELIRIC model could be a tool for predicting subsyndromal delirium using a cut‐off value of 36 points.

ICU Delirium-Prediction Models: A Systematic Review

“…Of the 18 included studies, 12 were primarily concerned with the development of new prediction models ( 28 – 39 ) and six with the validation of existing models ( 20 , 22 , 40 – 43 ) ( Table 1 ). These studies included 23 risk-prediction models, of which 12 were developed in the included studies.…”

“…Those studies that validated existing models had a sample size ranging from 38 to 2,178 participants ( 42 , 43 ). Delirium was most commonly assessed using CAM-ICU, though several studies used CAM ( 31 ), Nursing Delirium Screening Scale (NuDESC) ( 31 , 39 ), diagnostic and statistical manual of mental disorders (DSM) ( 20 , 36 ), and ICDSC ( 20 , 35 , 42 ).…”

“…Of the 23 models, five were externally validated by a separate study ( 20 , 22 , 40 – 43 ) and another seven were internally validated by a separate or split cohort ( 28 – 33 , 39 ). Five studies were retrospective and assessed delirium incidence through electronic health record data ( 20 , 33 , 35 , 36 , 40 ). Studies had various methods of assessing delirium including CAM-ICU, CAM, NuDESC, DSM, and ICDSC.…”

“…For model development studies, many included internal validation of their models. Sixteen of the 23 models were validated either internally through a split cohort or externally using data from a separate institution ( 20 , 22 , 29 – 31 , 33 , 39 – 43 ). The remaining seven models either lacked any validation or merely used bootstrapping ( 28 , 32 , 34 – 36 , 38 ).…”

“…The use of prediction models has shown promise in predicting several types of delirium, including postoperative and subsyndromal delirium as well as delirium in the ICU. These predictions can be used by clinicians as decision support for preventing and treating delirium ( 19 , 20 ). However, clinical adoption of delirium-prediction models has been limited, perhaps because most models are neither readily integrable into physician workflows or provide little clinical utility.…”