DeltaScan for the Assessment of Acute Encephalopathy and Delirium in ICU and non-ICU Patients, a Prospective Cross-Sectional Multicenter Validation Study.
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Ditzel Fienke L, Hut Suzanne C A, van den Boogaard Mark, Boonstra Michel, Leijten Frans S S, Wils Evert-Jan, van Nesselrooij Tim, Kromkamp Marjan, Rood Paul J T, Röder Christian, Bouvy Paul F, Coesmans Michiel, Osse Robert Jan, Pop-Purceleanu Monica, van Dellen Edwin, Krulder Jaap W M, Milisen Koen, Faaij Richard, Vondeling Ariël M, Kamper Ad M, van Munster Barbara C, de Jonghe Annemarieke, Winters Marian A M, van der Ploeg Jeanette, van der Zwaag Sanneke, Koek Dineke H L, Drenth-van Maanen Clara A C, Beishuizen Albertus, van den Bos Deirdre M, Cahn Wiepke, Schuit Ewoud, Slooter Arjen J C
Аннотация
DESIGN: Prospective cross-sectional study.
SETTING: Six Intensive Care Units (ICU's) and 17 non-ICU departments, including a psychiatric department across 10 Dutch hospitals.
PARTICIPANTS: 494 patients, median age 75 (IQR:64-87), 53% male, 46% in ICUs, 29% delirious.
MEASUREMENTS: DeltaScan recorded 4-minute EEGs, using an algorithm to select the first 96 seconds of artifact-free data for PDA detection. This algorithm was trained and calibrated on two independent datasets.
METHODS: Initial validation of the algorithm for AE involved comparing its output with an expert EEG panel's visual inspection. The primary objective was to assess DeltaScan's accuracy in identifying delirium against a delirium expert panel's consensus.
RESULTS: DeltaScan had a 99% success rate, rejecting 6 of the 494 EEG's due to artifacts. Performance showed and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.86 (95% CI: 0.83-0.90) for AE (sensitivity: 0.75, 95%CI=0.68-0.81, specificity: 0.87 95%CI=0.83-0.91. The AUC was 0.71 for delirium (95%CI=0.66-0.75, sensitivity: 0.61 95%CI=0.52-0.69, specificity: 72, 95%CI=0.67-0.77). Our validation aim was an NPV for delirium above 0.80 which proved to be 0.82 (95%CI: 0.77-0.86). Among 84 non-delirious psychiatric patients, DeltaScan differentiated delirium from other disorders with a 94% (95%CI: 87-98%) specificity.
CONCLUSIONS: DeltaScan can diagnose AE at bedside and shows a clear relationship with clinical delirium. Further research is required to explore its role in predicting delirium-related outcomes.