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Ditzel FL, Hut SCA, van den Boogaard M, Boonstra M, Leijten FSS, Wils EJ, van Nesselrooij T, Kromkamp M, Rood PJT, Röder C, Bouvy PF, Coesmans M, Osse RJ, Pop-Purceleanu M, van Dellen E, Krulder JWM, Milisen K, Faaij R, Vondeling AM, Kamper AM, van Munster BC, de Jonghe A, Winters MAM, van der Ploeg J, van der Zwaag S, Koek DHL, Drenth-van Maanen CAC, Beishuizen A, van den Bos DM, Cahn W, Schuit E, Slooter AJC. DeltaScan for the Assessment of Acute Encephalopathy and Delirium in ICU and non-ICU Patients, a Prospective Cross-Sectional Multicenter Validation Study. Am J Geriatr Psychiatry 2024; 32:1093-1104. [PMID: 38171949 DOI: 10.1016/j.jagp.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To measure the diagnostic accuracy of DeltaScan: a portable real-time brain state monitor for identifying delirium, a manifestation of acute encephalopathy (AE) detectable by polymorphic delta activity (PDA) in single-channel electroencephalograms (EEGs). 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.
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Affiliation(s)
- Fienke L Ditzel
- Department of Intensive Care Medicine and UMC Utrecht Brain Center (FLD, SCAH, MB, DMB, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Suzanne C A Hut
- Department of Intensive Care Medicine and UMC Utrecht Brain Center (FLD, SCAH, MB, DMB, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine (MB, PJTR), Radboud university medical center, Nijmegen, the Netherlands
| | - Michel Boonstra
- Department of Intensive Care Medicine and UMC Utrecht Brain Center (FLD, SCAH, MB, DMB, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology and UMC Utrecht Brain Center (FSSL), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care (E-JW), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Tim van Nesselrooij
- Department of Psychiatry and UMC Utrecht Brain Center (TN, MK, CR, ED, WC, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marjan Kromkamp
- Department of Psychiatry and UMC Utrecht Brain Center (TN, MK, CR, ED, WC, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J T Rood
- Department of Intensive Care Medicine (MB, PJTR), Radboud university medical center, Nijmegen, the Netherlands; HAN University of Applied Sciences (PJTR), School of Health Studies, Research Department of Emergency and Critical Care, Nijmegen, the Netherlands
| | - Christian Röder
- Department of Psychiatry and UMC Utrecht Brain Center (TN, MK, CR, ED, WC, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul F Bouvy
- Department of Psychiatry (PFB, MC, RJO), Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry (PFB, MC, RJO), Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert Jan Osse
- Department of Psychiatry (PFB, MC, RJO), Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monica Pop-Purceleanu
- Department of Psychiatry (MP-P), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry and UMC Utrecht Brain Center (TN, MK, CR, ED, WC, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology (ED, AJCS), UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Jaap W M Krulder
- Department of Geriatrics (JWMK), Franciscus Gasthuis&Vlietland, Rotterdam, the Netherlands
| | - Koen Milisen
- Department of Public Health and Primary Care (KM), Academic Center for Nursing and Midwifery, Katholieke Univerisiteit Leuven - University of Leuven, Leuven, Belgium; Department of Geriatric Medicine (KM), University Hospitals Leuven, Leuven, Belgium
| | - Richard Faaij
- Department of Geriatrics (RF, AMV), Diakonessenhuis, Utrecht, the Netherlands
| | - Ariël M Vondeling
- Department of Geriatrics (RF, AMV), Diakonessenhuis, Utrecht, the Netherlands
| | - Ad M Kamper
- Department of Geriatrics (AK, MAMW, JP, SZ), Isala, Zwolle, the Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine/Geriatrics (BCM), University Center of Geriatric Medicine, University Medical Center of Groningen, Groningen, the Netherlands; Alzheimer Center Groningen (BCM), Groningen, the Netherlands
| | | | - Marian A M Winters
- Department of Geriatrics (AK, MAMW, JP, SZ), Isala, Zwolle, the Netherlands
| | | | | | - Dineke H L Koek
- Department of Geriatrics (DHLK, CACDM), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Clara A C Drenth-van Maanen
- Department of Geriatrics (DHLK, CACDM), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Albertus Beishuizen
- Department of Intensive Care Medicine (AB), Medical Spectrum Twente, Enschede, the Netherlands
| | - Deirdre M van den Bos
- Department of Intensive Care Medicine and UMC Utrecht Brain Center (FLD, SCAH, MB, DMB, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry and UMC Utrecht Brain Center (TN, MK, CR, ED, WC, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care (ES), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and UMC Utrecht Brain Center (FLD, SCAH, MB, DMB, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Psychiatry and UMC Utrecht Brain Center (TN, MK, CR, ED, WC, AJCS), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology (ED, AJCS), UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
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Bruzzone MJ, Chapin B, Walker J, Santana M, Wang Y, Amini S, Kimmet F, Perera E, Rubinos C, Arias F, Price C. Electroencephalographic Measures of Delirium in the Perioperative Setting: A Systematic Review. Anesth Analg 2024:00000539-990000000-00887. [PMID: 39088366 DOI: 10.1213/ane.0000000000007079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Postoperative delirium (POD) is frequent in older adults and is associated with adverse cognitive and functional outcomes. In the last several decades, there has been an increased interest in exploring tools that easily allow the early recognition of patients at risk of developing POD. The electroencephalogram (EEG) is a widely available tool used to understand delirium pathophysiology, and its use in the perioperative setting has grown exponentially, particularly to predict and detect POD. We performed a systematic review to investigate the use of EEG in the pre-, intra-, and postoperative settings. We identified 371 studies, and 56 met the inclusion criteria. A range of techniques was used to obtain EEG data, from limited 1-4 channel setups to complex 256-channel systems. Power spectra were often measured preoperatively, yet the outcomes were inconsistent. During surgery, the emphasis was primarily on burst suppression (BS) metrics and power spectra, with a link between the frequency and timing of BS, and POD. The EEG patterns observed in POD aligned with those noted in delirium in different contexts, suggesting a reduction in EEG activity. Further research is required to investigate preoperative EEG indicators that may predict susceptibility to delirium.
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Affiliation(s)
- Maria J Bruzzone
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Benjamin Chapin
- Department of Anesthesia, University of Florida, Gainesville, Florida
| | - Jessie Walker
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Marcos Santana
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Yue Wang
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Shawna Amini
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Faith Kimmet
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Estefania Perera
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Clio Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Catherine Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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Ottens TH, Hermes C, Page V, Oldham M, Arora R, Bienvenu OJ, van den Boogaard M, Caplan G, Devlin JW, Friedrich ME, van Gool WA, Hanison J, Hansen HC, Inouye SK, Kamholz B, Kotfis K, Maas MB, MacLullich AMJ, Marcantonio ER, Morandi A, van Munster BC, Müller-Werdan U, Negro A, Neufeld KJ, Nydahl P, Oh ES, Pandharipande P, Radtke FM, Raedt SD, Rosenthal LJ, Sanders R, Spies CD, Vardy ERLC, Wijdicks EF, Slooter AJC. The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach. DELIRIUM (BIELEFELD, GERMANY) 2024; 2024:10.56392/001c.90652. [PMID: 38348284 PMCID: PMC10861222 DOI: 10.56392/001c.90652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Delirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment. However, current guidelines do not offer a structured approach to identification of underlying causes. A panel of 37 internationally recognised delirium experts from diverse medical backgrounds worked together in a modified Delphi approach via an online platform. Consensus was reached after five voting rounds. The final product of this project is a set of three delirium management algorithms (the Delirium Delphi Algorithms), one for ward patients, one for patients after cardiac surgery and one for patients in the intensive care unit.
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Affiliation(s)
- Thomas H Ottens
- Intensive Care Unit, Haga Teaching Hospital
- Intensive Care Medicine, University Medical Center Utrecht
| | - Carsten Hermes
- Intensive Care Unit, Haga Teaching Hospital
- Intensive Care Medicine, University Medical Center Utrecht
- Critical Care, Watford General Hospital
- School of Medicine and Dentisty, University of Rochester
- Psychiatry, University of Rochester Medical Center
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland
- Division of Cardiac Surgery, Case Western Reserve University
- School of Medicine, Johns Hopkins University
- Intensive Care Medicine, Radboud University Nijmegen Medical Centre
- School of Clinical Medicine, UNSW Sydney
- Geriatric Medicine, Prince of Wales Hospital
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital
- Bouve College of Health Sciences, Northeastern University
- Abteilung für Sozialpsychiatrie, Hollabrunn, Austria
- Neurology, Amsterdam University Medical Centers
- Anaesthesia, Manchester University NHS Foundation Trust
- Neurology, Friedrich-Ebert-Krankenhaus
- Beth Israel Deaconess Medical Center
- Harvard Medical School
- Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University
- Neurology, Northwestern Medicine
- Feinberg School of Medicine, Northwestern University
- Usher Institute Ageing and Health, University of Edinburgh
- Geriatric Medicine, Beth Israel Deaconess Medical Center
- Rehabilitation, Fondazione Teresa Camplani
- Geriatric Medicine, University Medical Center Groningen
- Geriatrics, Charité - Universitätsmedizin Berlin
- Intensive Care Unit, IRCCS Ospedale San Raffaele
- Faculty of Health Sciences, McMaster University
- Intensive Care Unit, University Hospital Schleswig-Holstein
- Geriatric Medicine and Gerontology, Johns Hopkins Medicine
- Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center
- University of Southern Denmark
- Anaesthesia and Intensive Care, Nykøbing F. Hospital
- Vrije Universiteit Brussel
- Neurology, Universitair Ziekenhuis Brussel
- Psychiatry, Northwestern Memorial Hospital
- Faculty of Medicine and Health, University of Sydney
- Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin
- Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom
- University of Manchester, Manchester, United Kingdom
- Neurology, Mayo Clinic
- Psychiatry, University Medical Center Utrecht
- Brain Center, University Medical Center Utrecht
| | | | - Mark Oldham
- School of Medicine and Dentisty, University of Rochester
- Psychiatry, University of Rochester Medical Center
| | - Rakesh Arora
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland
- Division of Cardiac Surgery, Case Western Reserve University
| | | | | | - Gideon Caplan
- School of Clinical Medicine, UNSW Sydney
- Geriatric Medicine, Prince of Wales Hospital
| | - John W Devlin
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital
- Bouve College of Health Sciences, Northeastern University
| | | | | | - James Hanison
- Anaesthesia, Manchester University NHS Foundation Trust
| | | | | | - Barbara Kamholz
- Intensive Care Unit, Haga Teaching Hospital
- Intensive Care Medicine, University Medical Center Utrecht
- Critical Care, Watford General Hospital
- School of Medicine and Dentisty, University of Rochester
- Psychiatry, University of Rochester Medical Center
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland
- Division of Cardiac Surgery, Case Western Reserve University
- School of Medicine, Johns Hopkins University
- Intensive Care Medicine, Radboud University Nijmegen Medical Centre
- School of Clinical Medicine, UNSW Sydney
- Geriatric Medicine, Prince of Wales Hospital
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital
- Bouve College of Health Sciences, Northeastern University
- Abteilung für Sozialpsychiatrie, Hollabrunn, Austria
- Neurology, Amsterdam University Medical Centers
- Anaesthesia, Manchester University NHS Foundation Trust
- Neurology, Friedrich-Ebert-Krankenhaus
- Beth Israel Deaconess Medical Center
- Harvard Medical School
- Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University
- Neurology, Northwestern Medicine
- Feinberg School of Medicine, Northwestern University
- Usher Institute Ageing and Health, University of Edinburgh
- Geriatric Medicine, Beth Israel Deaconess Medical Center
- Rehabilitation, Fondazione Teresa Camplani
- Geriatric Medicine, University Medical Center Groningen
- Geriatrics, Charité - Universitätsmedizin Berlin
- Intensive Care Unit, IRCCS Ospedale San Raffaele
- Faculty of Health Sciences, McMaster University
- Intensive Care Unit, University Hospital Schleswig-Holstein
- Geriatric Medicine and Gerontology, Johns Hopkins Medicine
- Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center
- University of Southern Denmark
- Anaesthesia and Intensive Care, Nykøbing F. Hospital
- Vrije Universiteit Brussel
- Neurology, Universitair Ziekenhuis Brussel
- Psychiatry, Northwestern Memorial Hospital
- Faculty of Medicine and Health, University of Sydney
- Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin
- Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom
- University of Manchester, Manchester, United Kingdom
- Neurology, Mayo Clinic
- Psychiatry, University Medical Center Utrecht
- Brain Center, University Medical Center Utrecht
| | - Katarzyna Kotfis
- Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University
| | - Matthew B Maas
- Neurology, Northwestern Medicine
- Feinberg School of Medicine, Northwestern University
| | | | | | | | | | | | | | | | - Peter Nydahl
- Intensive Care Unit, University Hospital Schleswig-Holstein
| | - Esther S Oh
- Geriatric Medicine and Gerontology, Johns Hopkins Medicine
| | | | - Finn M Radtke
- University of Southern Denmark
- Anaesthesia and Intensive Care, Nykøbing F. Hospital
| | - Sylvie De Raedt
- Vrije Universiteit Brussel
- Neurology, Universitair Ziekenhuis Brussel
| | - Lisa J Rosenthal
- Feinberg School of Medicine, Northwestern University
- Psychiatry, Northwestern Memorial Hospital
| | | | - Claudia D Spies
- Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin
| | - Emma R L C Vardy
- Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | | | - Arjen J C Slooter
- Intensive Care Medicine, University Medical Center Utrecht
- Psychiatry, University Medical Center Utrecht
- Brain Center, University Medical Center Utrecht
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