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Systematic review of prediction models for delirium in the older adult inpatient
  1. Heidi Lindroth1,2,
  2. Lisa Bratzke3,
  3. Suzanne Purvis4,
  4. Roger Brown3,
  5. Mark Coburn5,
  6. Marko Mrkobrada6,
  7. Matthew T V Chan7,
  8. Daniel H J Davis8,
  9. Pratik Pandharipande9,
  10. Cynthia M Carlsson1,14,15,16,17,
  11. Robert D Sanders1
  1. 1 Department of Anesthesiology, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  2. 2 School of Nursing, University of Wisconsin Madison, Madison, Wisconsin, USA
  3. 3 School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
  4. 4 Department of Nursing, University Hospital, Madison, Wisconsin, USA
  5. 5 Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
  6. 6 Department of Medicine, Western University, London, Ontario, Canada
  7. 7 Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
  8. 8 MRC Unit for Lifelong Health and Ageing, University College London, London, UK
  9. 9 Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  10. 14 Department of Medicine, Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  11. 15 Geriatric Research, Education, and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
  12. 16 Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin, USA
  13. 17 Wisconsin Alzheimer’s Institute, Madison, Wisconsin, USA
  1. Correspondence to Heidi Lindroth; hlindroth{at}wisc.edu

Abstract

Objective To identify existing prognostic delirium prediction models and evaluate their validity and statistical methodology in the older adult (≥60 years) acute hospital population.

Design Systematic review.

Data sources and methods PubMed, CINAHL, PsychINFO, SocINFO, Cochrane, Web of Science and Embase were searched from 1 January 1990 to 31 December 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and CHARMS Statement guided protocol development. Inclusion criteria: age >60 years, inpatient, developed/validated a prognostic delirium prediction model. Exclusion criteria: alcohol-related delirium, sample size ≤50. The primary performance measures were calibration and discrimination statistics. Two authors independently conducted search and extracted data. The synthesis of data was done by the first author. Disagreement was resolved by the mentoring author.

Results The initial search resulted in 7,502 studies. Following full-text review of 192 studies, 33 were excluded based on age criteria (<60 years) and 27 met the defined criteria. Twenty-three delirium prediction models were identified, 14 were externally validated and 3 were internally validated. The following populations were represented: 11 medical, 3 medical/surgical and 13 surgical. The assessment of delirium was often non-systematic, resulting in varied incidence. Fourteen models were externally validated with an area under the receiver operating curve range from 0.52 to 0.94. Limitations in design, data collection methods and model metric reporting statistics were identified.

Conclusions Delirium prediction models for older adults show variable and typically inadequate predictive capabilities. Our review highlights the need for development of robust models to predict delirium in older inpatients. We provide recommendations for the development of such models.

  • delirium
  • geriatric medicine
  • statistic

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors HL and SP with the mentorship of RDS formulated the aim, developed the study protocol, completed the search and extracted the data. HL and RDS synthesised the data. HL with the mentorship of RDS drafted the manuscript and designed the tables. RB designed the figures and assisted with statistical interpretation. LB provided expertise on content related to cognition and reviewed the manuscript. DHJD and CMC assisted with synthesis and interpretation of results and discussion in relation to their expertise in geriatrics, cognition and delirium. MC, MM, MTVC and PP assisted with synthesis of results and discussion section, providing expertise in delirium in its respective settings.

  • Funding HL and RDS acknowledge funding support from the Department of Anesthesiology at University of Wisconsin-Madison. RDS acknowledges funding support from K23 AG055700. PP acknowledges funding support from R01 NHLBI(HL111111) and research grant from Hospira Inc in collaboration with National Institutes of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Complete search results including excluded studies and CHARMS Risk of Bias checklist decision tree available from corresponding author upon request.

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