External validation of two models to predict delirium in critically ill adults using either the confusion assessment method-ICU or the intensive care delirium screening checklist for delirium assessment

Abstract

Objectives: To externally validate two delirium prediction models (the E-PRE-DELIRIC and recalibrated PRE-DELIRIC) and compare the performance of each model usingboth ConfusionAssessment Method-ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC)deliriumassessment scores.

Design: Prospective,multinational cohort study.

Setting: ElevenICUs from seven countries in 3 continents.

Patients: Consecutive, delirium-free adults admitted tothe ICU for ≥ 6 hours in whom delirium could be reliably assessed.

Interventions: None.

Measurements and Main Results: The predictors included in eachmodel were collected (E-PRE-DELIRIC: at the time of ICU admission; PRE-DELIRIC:within 24 hours of ICU admission). Delirium was assessed using the CAM-ICU or ICDSC. Discriminationand calibration of bothmodels was assessed for the total cohort and also for patients evaluated witheach delirium assessment tool. Discrimination was determined using the area under the receiveroperating characteristic curve (AUROC). The predictive performance using the CAM-ICU or ICDSC was compared and the performance of the total cohortwas compared with the original results for each model. Calibration was assessedgraphically. A total of 2,178 patients were included. Deliriumincidence was 21.4%. TheAUROC of the E-PRE-DELIRIC model was 0.68 (95%CI 0.66-0.71) versusprior reported AUROC of 0.75 (95%CI 0.71-0.79). TheAUROC of the recalibrated PRE-DELIRIC model was 0.74 (95%CI 0.71-0.76) versusprior AUROC of 0.77 (95%CI 0.74-0.79). Bothmodels were well calibrated. Use of CAM-ICU or the ICDSC did not significantly affect the AUROC for eitherthe E-PRE-DELIRIC [Z-score of -0.91 (p>0.1] or PRE-DELIRIC [Z-score of 1.50(p>0.1)] model.

 Conclusions: Using alarge, heterogeneous, multinational cohort of critically ill adults, evaluatedwith either the CAM-ICU or ICDSC, we show that the E-PRE-DELIRIC and PRE-DELIRIC models both statistically perform at a moderately-to-goodlevel. These results allowfor generalization to ICUs around the world.

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