Abstract
Objective:
This methodological study was conducted in order to carry out the adaptation and validation of the “PRE-DELIRIC score” prediction of delirium model in Türkiye among patients hospitalized in the intensive care unit (ICU).
Materials and Methods:
The research involved 172 patients treated in the intensive care units of a training and research hospital between October 2019 and April 2020. The study data were collected using (1) a data collection form to determine the participants’ descriptive characteristics, (2) the PRE-DELIRIC score, and (3) the Confusion Assessment Method for the ICU (CAM-ICU). Receiver operating characteristic (ROC) analysis and diagnostic screening tests were applied for the purpose of determining cut-off points for the groups. The scores’ sensitivity and specificity were calculated. Significance was evaluated at the p<0.05 level.
Results:
A statistically significant association was determined between the cut-off point obtained for the PRE-DELIRIC score (≥7.58%) and the study groups (p=0.003). Patients with PRE-DELIRIC scores of 7.58 or higher exhibited a 7.404-fold greater risk of being CAM-ICU-positive [odds ratio: 7.404; 95% confidence interval (CI): 1.638-33.469]. The area under the ROC curve was 64.9% (95% CI: 0.538-0.760), and the standard error was 5.6% (p=0.044).
Conclusion:
The PRE-DELIRIC score yielded reliable results in this study. It appears significant for patients with a likelihood of developing delirium within the ICU, and its use is recommended as a functional score that is easily applied and calculated.
Keywords: Critical care, PRE-DELIRIC, delirium, model
References
- European Delirium Association; American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med 2014;12:141.
- Brummel NE, Girard TD, Ely EW, Pandharipande PP, Morandi A, Hughes CG, et al. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. Intensive Care Med 2014;40:370-9.
- Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015;350:h2538.
- Linkaitė G, Riauka M, Buneviiūtė I, Vosylius S. Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit. Acta Med Litu 2018;25:14-22.
- Kırkpınar İ. Assessing and Managing Delirium in Surgical and Internal Medicine: an Overview. Bezmialem Science 2016;3:113-22.
- Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001;286:2703-10.
- Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001;27:859-64.
- Sutter R. Predicting the Unpredictable-How to Score the Risk of Delirium in Critically Ill Patients. Crit Care Med 2019;47:484-6.
- Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263-306.
- van den Boogaard M, Schoonhoven L, Maseda E, Plowright C, Jones C, Luetz A, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med 2014;40:361-9.
- Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for intensive care delirium: a systematic review. Intensive Crit Care Nurs 2008;24:98-107.
- Lee A, Mu JL, Joynt GM, Chiu CH, Lai VKW, Gin T, et al. Risk prediction models for delirium in the intensive care unit after cardiac surgery: a systematic review and independent external validation. Br J Anaesth 2017;118:391-9.
- Green C, Bonavia W, Toh C, Tiruvoipati R. Prediction of ICU Delirium: Validation of Current Delirium Predictive Models in Routine Clinical Practice. Crit Care Med 2019;47:428-35.
- İnal MT, Memiş D, İnal V, Uyar AŞ, Tek ŞÇ, Çiftçi T, et al. Yoğun bakım hastalarında Predeliryum Skorunun değerlendirilmesi. Turk J Intense Care 2018;16:26-9.
- Balas MC, Vasilevskis EE, Burke WJ, Boehm L, Pun BT, Olsen KM, et al. Critical care nurses’ role in implementing the “ABCDE bundle” into practice. Crit Care Nurse 2012;32:35-8, 40-7; quiz 48.
- Grover S, Kate N. Assessment scales for delirium: A review. World J Psychiatry 2012;2:58-70.
- Yaşayacak A, Eker F. Kalp damar cerrahisi yoğun bakım ünitesinde yatan hastalarda deliryum ve risk faktörlerinin belirlenmesi. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2012;20:265-74.
- Akıncı SB, Rezaki M, Özdemir H, Çelikcan A, Kanbak M, Yorgancı K et al. Yoğun bakım ünitesinde Konfüzyon Değerlendirme Ölçeği’nin geçerlik güvenilirlik çalışması. Türk Anesteziyoloji ve Reanimasyon Dergisi 2005;33:333-3341.
- Sosa FA, Roberti J, Franco MT, Kleinert MM, Patrón AR, Osatnik J. Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina. Rev Bras Ter Intensiva 2018;30:50-6.
- Lin WL, Chen WF, Wang J. Factors associated with the development of delirium in elderly patients in intensive care units. JNR 2015;4:322-9.
- Kalabalik J, Brunetti L, El-Srougy R. Intensive care unit delirium: a review of the literature. J Pharm Pract 2014;27:195-207.
- Aliberti S, Bellelli G, Belotti M, Morandi A, Messinesi G, Annoni G, et al. Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia. Aging Clin Exp Res 2015;27:523-31.
- Pauley E, Lishmanov A, Schumann S, Gala GJ, van Diepen S, Katz JN. Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit. Am Heart J 2015;170:79-86
- Wolters AE, van Dijk D, Pasma W, Cremer OL, Looije MF, de Lange DW, et al. Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Crit Care 2014:18;18:R125.
- Guenther U, Wolke M, Hansen HC, Feldman N, Diers A, Dewald O, et al. Bedeutung der Desorientierung bei der Delireinschätzung : Sekundäranalyse einer prospektiven, observationellen Studie [Disorientation and delirium assessment: A secondary analysis of aprospective, observational study]. Med Klin Intensivmed Notfmed 2022;117:419-27.
- Gusmao-Flores D, Salluh JI, Chalhub RÁ, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care 2012;16:R115.
- Wassenaar A, Schoonhoven L, Devlin JW, van Haren FMP, Slooter AJC, Jorens PG, et al. Delirium prediction in the intensive care unit: comparison of two delirium prediction models. Crit Care 2018;22:114.
- Heesakkers H, Devlin JW, Slooter AJC, van den Boogaard M. Association between delirium prediction scores and days spent with delirium. J Crit Care 2020;58:6-9.
- Liang S, Chau JPC, Lo SHS, Bai L, Yao L, Choi KC. Validation of PREdiction of DELIRium in ICu patients (PRE-DELIRIC) among patients in intensive care units: A retrospective cohort study. Nurs Crit Care 2021;26:176-82.
- Huai J, Ye X. A meta-analysis of critically ill patients reveals several potential risk factors for delirium. Gen Hosp Psychiatry 2014;36:488-96.
- Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med 2015;43:40-7.
- Ho MH, Chen KH, Montayre J, Liu MF, Chang CC, Traynor V, et al. Diagnostic test accuracy meta-analysis of PRE-DELIRIC (PREdiction of DELIRium in ICu patients): A delirium prediction model in intensive care practice. Intensive Crit Care Nurs 2020;57:102784.
- Paton L, Elliott S, Chohan S. Utility of the PRE-DELIRIC delirium prediction model in a Scottish ICU cohort. J Intensive Care Soc 2016;17:202-206.
Copyright and license
Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.