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

van den Boogaard, M., Schoonhoven, L., Maseda, E. , Plowright, C., Jones, C., Luetz, A., Sackey, P. V., Jorens, P., Aitken, L. M., van Haren, F. M. P., Donders, R., van der Hoeven, J. G. & Pickkers, P. (2014). Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Medicine, 40(3), pp. 361-369. doi: 10.1007/s00134-013-3202-7

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.

Publication Type: Article
Additional Information: The final publication is available at Springer via http://dx.doi.org/10.1007/s00134-013-3202-7
Publisher Keywords: delirium, prediction model, recalibration, critical care
Subjects: R Medicine > RT Nursing
Departments: School of Health Sciences > Nursing
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