Validation of a delirium predictive model in patients admitted to surgical intensive care units: a multicentre prospective observational cohort study.

Abstract

OBJECTIVE:

To internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.

DESIGN:

A prospective, observational, multicentre study.

SETTING:

Three university-affiliated teaching hospitals in Thailand.

PARTICIPANTS:

Adults aged over 18 years were enrolled if they were admitted to a surgical ICU (SICU) and had the surgery within 7 days before SICU admission.

MAIN OUTCOME MEASURES:

Postoperative delirium was assessed using the Thai version of the Confusion Assessment Method for the ICU. The assessments commenced on the first day after the patient's operation and continued for 7 days, or until either discharge from the ICU or the death of the patient. Validation was performed of the previously developed delirium predictive model: age+(5×SOFA)+(15×benzodiazepine use)+(20×DM)+(20×mechanical ventilation)+(20×modified IQCODE>3.42).

RESULTS:

In all, 380 SICU patients were recruited. Internal validation on 150 patients with the mean age of 75±7.5 years resulted in an area under a receiver operating characteristic curve (AUROC) of 0.76 (0.683 to 0.837). External validation on 230 patients with the mean age of 57±17.3 years resulted in an AUROC of 0.85 (0.789 to 0.906). The AUROC of all validation cohorts was 0.83 (0.785 to 0.872). The optimum cut-off value to discriminate between a high and low probability of postoperative delirium in SICU patients was 115. This cut-off offered the highest value for Youden's index (0.50), the best AUROC, and the optimum values for sensitivity (78.9%) and specificity (70.9%).

CONCLUSIONS:

The model developed by the previous study was able to predict the occurrence of postoperative delirium in critically ill surgical patients admitted to SICUs.

TRIAL REGISTRATION NUMBER:

Thai Clinical Trail Registry (TCTR20180105001).

• Authors: Onuma Chaiwat, Kaweesak Chittawatanarat, Sirirat Mueankwan, Sunthiti Morakul, Pitchaya Dilokpattanamongkol, Chayanan Thanakiattiwibun, Arunotai Siriussawakul
• Journal: BMJ open (BMJ Open) Vol. 12 Issue 6 Pg. e057890 (06 21 2022) ISSN: 2044-6055 [Electronic] England
• PMID: 35728902 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Adult
• Aged
• Aged, 80 and over
• Critical Care
• Critical Illness
• Delirium (diagnosis, epidemiology, etiology)
• Humans
• Intensive Care Units
• Middle Aged
• Prospective Studies