Delirium (PRE-DELIRIC) prediction model for intensive care patients, version 2 (recalibrated)
The recalibrated PRE-DELIRIC model (version 2) for intensive care patients consists of 10 risk factors that are readily available within 24 hours after intensive care admission and has a high predictive value. The model allows for early prediction of delirium and initiation of preventive measures.
Research authors: van den Boogaard M, Schoonhoven L, Maseda E, Plowright C, Jones C, Luetz A, Sackey PV, Jorens PG, Aitken LM, van Haren FM, Donders R, van der Hoeven JG, and Pickkers P.
Details Formula Study characteristics Files & References
★★★★
Model author
Model ID
608
Version
1.24
Revision date
2018-06-07
Specialty
MeSH terms
  • Delirium
  • Intensive Care
  • Clinical Prediction Rule
  • Primary Prevention
  • Model type
    Logistic regression (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    Study design: 
    A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries.1

    Study population: 
    A total of 2,852 adult ICU patients were screened of which 1,824 (64 %) were eligible for the study. Main reasons for exclusion were length of stay <1 day (19.1 %) and sustained coma (4.1 %). CAM-ICU compliance was mean (SD) 82 ± 16 % and inter-rater reliability 0.87 ± 0.17. The median delirium incidence was 22.5 % (IQR 12.8–36.6 %).1

    Model calibration: 
    In 2012, van den Boogaard et al developed and validated the PRE-DELIRIC model (version 1) based on 10  risk factors for delirium in ICU patients.Since the PRE-DELIRIC model was developed and validated in the Netherlands, the multinational performance of this model has not been known. In view of relevant differences in case mix and ICU treatment between countries, a good multinational performance of the PRE-DELIRIC model was deemed necessary prior to worldwide implementation. In the present study, the authors recalibrated the model and determined the discriminative power of the PRE-DELIRIC model.1

    Statistical analysis: 
    To recalibrate the prediction model, four different approaches were used and calculated, as described in “Statistical analysis” of the original research paper.1 


    Source: 
    [1] van den Boogaard M, Schoonhoven L, Maseda E, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40(3):361-9. 
    [2] van den Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.

    Study Population

    Total population size: 1824

    Continuous characteristics

    Name Mean SD Unit
    Age 60 15 years
    APACHE-II score 20 10 points

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Delirium Yes 264
    No 1560
    Urgent admission Yes 858
    No 966
    Coma No coma 1229
    Coma, drug-induced 197
    Coma, miscellaneous 11
    Coma, combination 80
    Sedation Yes 647
    No 1177
    Admission category Surgery 773
    Medical 455
    Trauma 93
    Neurology/neurosurgery 197
    Metabolic acidosis Yes 426
    No 1398
    Morphine use No morphine use 1092
    0.01-7.1 mg/day 73
    7.2-18.6 m/day 109
    >18.6 mg/day 82

    Risk of delirium in intensive care unit patient:
    ...

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    Risk of delirium in intensive care unit patient:

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    Conditional information

    Result interpretation

    How this model should be used: 
    The recalibrated PRE-DELIRIC model (version 2) for intensive care patients consists of ten risk factors that are readily available within 24 hours afterintensive care admission and has a high predictive value. The model allows for early prediction of delirium and initiation of preventive measures.1

    Model performance: 
    An international multicenter validation study of a previously developed model2 was performed including 1,824 ICU patients. Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the eight participating centers remained good: 0.77 (95 % CI 0.74–0.79). Recalibration resulted in improved re-calibration of the PRE-DELIRIC model.
     
    Source: 
    [1] van den Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.
    [2] van den Boogaard M, Schoonhoven L, Maseda E, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40(3):361-9. 
     

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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