• Annelies Wassenaar, Lisette Schoonhoven, John W Devlin, van Haren Frank M P FMP Intensive Care Unit, The Canberra Hospital, Canberra, Australia. Faculty of Heal, Slooter Arjen J C AJC Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands., Philippe G Jorens, Mathieu van der Jagt, Koen S Simons, Ingrid Egerod, Lisa D Burry, Albertus Beishuizen, Joaquim Matos, Donders A Rogier T ART Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands., Peter Pickkers, and Mark van den Boogaard.
• Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
• Crit Care. 2018 May 5; 22 (1): 114.

BackgroundAccurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction  model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation.MethodsThis 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h.ResultsIn total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71-0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66-0.71)) (z score of - 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible.ConclusionsWhile both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h.Trial RegistrationClinicalTrials.gov, NCT02518646 . Registered on 21 July 2015.

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