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Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study.

Abstract：

PURPOSE:Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients. METHODS:A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 h after ICU admission. The confusion assessment method for the intensive care unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data. RESULTS:A total of 2,852 adult ICU patients were screened of which 1,824 (64%) were eligible for the study. Main reasons for exclusion were length of stay <1 day (19.1%) and sustained coma (4.1%). CAM-ICU compliance was mean (SD) 82 ± 16% and inter-rater reliability 0.87 ± 0.17. The median delirium incidence was 22.5% (IQR 12.8-36.6%). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the eight participating centers remained good: 0.77 (95% CI 0.74-0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved re-calibration of the PRE-DELIRIC model. CONCLUSIONS:In this multinational study, we recalibrated the PRE-DELIRIC model. Despite differences in the incidence of predictors between the centers in the different countries, the performance of the PRE-DELIRIC-model remained good. Following validation of the PRE-DELIRIC model, it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

van den Boogaard M,Schoonhoven L,Maseda E,Plowright C,Jones C,Luetz A,Sackey PV,Jorens PG,Aitken LM,van Haren FM,Donders R,van der Hoeven JG,Pickkers P

doi

10.1007/s00134-013-3202-7

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

361-9

issue

eissn

0342-4642

issn

1432-1238

journal_volume

pub_type

杂志文章,多中心研究

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Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study.