Development and validation of PRE-DELIRIC(PREdiction of DELIRium in ICu patients) deliriumprediction model for intensive care patients:observational multicentre study
professor in critical care
, A J C Slooter
, M A Kuiper
, P E Spronk
, P H Jvan der Voort
, J G van der Hoeven
professor in critical care
, R Donders
,T van Achterberg
professor in nursing
, L Schoonhoven
senior research fellow nursing science
Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, Netherlands;
Department of IntensiveCare,UniversityMedicalCentreUtrecht,Utrecht,Netherlands;
Department of Intensive Care Medicine, Gelre Hospitals, Location Lukas, Apeldoorn, Netherlands;
Department of Intensive Care, Onze LieveVrouwe Gasthuis, Amsterdam, Netherlands;
Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre;
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre
Todevelopandvalidateadeliriumpredictionmodelforadultintensivecarepatientsanddetermineitsadditionalvaluecomparedwithprediction by caregivers.
Observational multicentre study.
Five intensive care units in the Netherlands (two universityhospitals and three university affiliated teaching hospitals).
3056 intensive care patients aged 18 years or over.
Main outcome measure
Development of delirium (defined as at leastone positive delirium screening) during patients’ stay in intensive care.
The model was developed using 1613 consecutive intensivecarepatientsinonehospitalandtemporallyvalidatedusing549patientsfromthesamehospital.Forexternalvalidation,datawerecollectedfrom894patientsinfourotherhospitals.Theprediction(PRE-DELIRIC)modelcontains10riskfactors—age,APACHE-IIscore,admissiongroup,coma,infection, metabolic acidosis, use of sedatives and morphine, ureaconcentration, and urgent admission. The model had an area under thereceiveroperatingcharacteristicscurveof0.87(95%confidenceinterval0.85 to 0.89) and 0.86 after bootstrapping. Temporal validation andexternal validation resulted in areas under the curve of 0.89 (0.86 to0.92) and 0.84 (0.82 to 0.87). The pooled area under the receiveroperating characteristics curve (n=3056) was 0.85 (0.84 to 0.87). Thearea under the curve for nurses’ and physicians’ predictions (n=124)was significantly lower at 0.59 (0.49 to 0.70) for both.
ThePRE-DELIRICmodelforintensivecarepatientsconsistsof10riskfactorsthatarereadilyavailablewithin24hoursafterintensivecare admission and has a high predictive value. Clinical prediction bynurses and physicians performed significantly worse. The model allowsfor early prediction of delirium and initiation of preventive measures.
ClinicaltrialsNCT00604773(developmentstudy)andNCT00961389 (validation study).
Delirium,characterised by an acute onsetof fluctuating changesin mental status and changed levels of consciousness andinattentiveness,
has a high incidence rate in critically illpatients.
It is a serious disorder associated with prolongedstays in intensive care units and hospitals, higher costs, andincreased morbidity and mortality.
2 3 5
Several tools are available for assessing delirium in intensivecare patients, of which the confusion assessmentmethod—intensive care unit (CAM-ICU) has the highestsensitivity and specificity.
Screening intensive care patientsis important,
so that timely treatment can be provided.However, preventive measures for delirium may also reduce itsincidence, severity, and duration, as determined in other groupsof patients.
General preventive measures in all intensive carepatients are time consuming and may expose a substantialnumber of patients to unnecessary risks such as the adverse
2012;344:e420 doi: 10.1136/bmj.e420 (Published 9 February 2012) Page 1 of 11