Evaluation of emergency department derived delirium prediction models using a hospital-wide cohort

Sangil Lee, Karisa Harland, Nicholas M. Mohr, Grace Matthews, Erik P. Hess, M. Fernanda Bellolio, Jin H. Han, Michelle Weckmann, Ryan Carnahan

Research output: Contribution to journalArticle

Abstract

Objective: Delirium is acute disorder of attention and cognition. We conducted an observational study using a hospital-wide database to validate three delirium prediction models that were developed to predict prevalent delirium within the first day of hospitalization after ED visit. Methods: This was a retrospective cohort study at the academic medical center to evaluate the predictive ability of three previously developed prediction models for delirium from 2014 to 2017. We included patients aged 65 years and older who were hospitalized from ED. Nurses used the Delirium Observation Screening Scale (DOSS) twice daily while hospitalized. We extracted variables to examine the three prediction models with a positive DOSS screen within the first day of admission. The predictive ability was summarized using the area under the curve (AUC). Results: We identified 2582 visits with a positive DOSS screen and 877 visits with a diagnosis of delirium from ICD9/10 codes among 12,082 encounters. The AUC of these prediction models ranged from 0.71 to 0.80 when predicting a positive DOSS screen, and 0.68 to 0.72 when predicting a ICD9/10 diagnosis of delirium. In our cohort, the delirium risk score which uses the cutoff of positive or negative predicted DOSS positive delirium with the AUC of 0.8 (p <.0001). The model demonstrated the sensitivity and the specificity of 91.2 (95% CI 90.0–92.3) and 50.3 (95% CI 49.3–51.3). Conclusion: In this study, the delirium risk score had the highest predictive ability for prevalent delirium defined by a positive DOSS within the first day of hospitalization.

Original languageEnglish (US)
Article number109850
JournalJournal of Psychosomatic Research
Volume127
DOIs
StatePublished - Dec 2019

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Delirium
Hospital Emergency Service
Observation
Aptitude
Area Under Curve
Hospitalization
Cognition Disorders

Keywords

  • Delirium
  • Emergency department
  • Prediction
  • Validation

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Evaluation of emergency department derived delirium prediction models using a hospital-wide cohort. / Lee, Sangil; Harland, Karisa; Mohr, Nicholas M.; Matthews, Grace; Hess, Erik P.; Bellolio, M. Fernanda; Han, Jin H.; Weckmann, Michelle; Carnahan, Ryan.

In: Journal of Psychosomatic Research, Vol. 127, 109850, 12.2019.

Research output: Contribution to journalArticle

Lee, Sangil ; Harland, Karisa ; Mohr, Nicholas M. ; Matthews, Grace ; Hess, Erik P. ; Bellolio, M. Fernanda ; Han, Jin H. ; Weckmann, Michelle ; Carnahan, Ryan. / Evaluation of emergency department derived delirium prediction models using a hospital-wide cohort. In: Journal of Psychosomatic Research. 2019 ; Vol. 127.
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abstract = "Objective: Delirium is acute disorder of attention and cognition. We conducted an observational study using a hospital-wide database to validate three delirium prediction models that were developed to predict prevalent delirium within the first day of hospitalization after ED visit. Methods: This was a retrospective cohort study at the academic medical center to evaluate the predictive ability of three previously developed prediction models for delirium from 2014 to 2017. We included patients aged 65 years and older who were hospitalized from ED. Nurses used the Delirium Observation Screening Scale (DOSS) twice daily while hospitalized. We extracted variables to examine the three prediction models with a positive DOSS screen within the first day of admission. The predictive ability was summarized using the area under the curve (AUC). Results: We identified 2582 visits with a positive DOSS screen and 877 visits with a diagnosis of delirium from ICD9/10 codes among 12,082 encounters. The AUC of these prediction models ranged from 0.71 to 0.80 when predicting a positive DOSS screen, and 0.68 to 0.72 when predicting a ICD9/10 diagnosis of delirium. In our cohort, the delirium risk score which uses the cutoff of positive or negative predicted DOSS positive delirium with the AUC of 0.8 (p <.0001). The model demonstrated the sensitivity and the specificity of 91.2 (95{\%} CI 90.0–92.3) and 50.3 (95{\%} CI 49.3–51.3). Conclusion: In this study, the delirium risk score had the highest predictive ability for prevalent delirium defined by a positive DOSS within the first day of hospitalization.",
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AB - Objective: Delirium is acute disorder of attention and cognition. We conducted an observational study using a hospital-wide database to validate three delirium prediction models that were developed to predict prevalent delirium within the first day of hospitalization after ED visit. Methods: This was a retrospective cohort study at the academic medical center to evaluate the predictive ability of three previously developed prediction models for delirium from 2014 to 2017. We included patients aged 65 years and older who were hospitalized from ED. Nurses used the Delirium Observation Screening Scale (DOSS) twice daily while hospitalized. We extracted variables to examine the three prediction models with a positive DOSS screen within the first day of admission. The predictive ability was summarized using the area under the curve (AUC). Results: We identified 2582 visits with a positive DOSS screen and 877 visits with a diagnosis of delirium from ICD9/10 codes among 12,082 encounters. The AUC of these prediction models ranged from 0.71 to 0.80 when predicting a positive DOSS screen, and 0.68 to 0.72 when predicting a ICD9/10 diagnosis of delirium. In our cohort, the delirium risk score which uses the cutoff of positive or negative predicted DOSS positive delirium with the AUC of 0.8 (p <.0001). The model demonstrated the sensitivity and the specificity of 91.2 (95% CI 90.0–92.3) and 50.3 (95% CI 49.3–51.3). Conclusion: In this study, the delirium risk score had the highest predictive ability for prevalent delirium defined by a positive DOSS within the first day of hospitalization.

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