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Delirium screening in the intensive care unit using emerging QEEG techniques: A pilot study.

ABSTRACT: Delirium is an under-diagnosed yet frequently occurring clinical complication with potentially serious consequences for intensive care unit (ICU) patients. Diagnosis is currently reactive and based upon qualitative assessment of the patient's cognitive status by ICU staff. Here, we conducted a preliminary investigation into whether emerging quantitative electroencephalography (QEEG) analysis techniques can accurately discriminate between delirious and non-delirious patients in an ICU setting. Resting EEG recordings from 5 ICU patients in a state of delirium and 5 age matched control patients were analyzed using autoregressive spectral estimation for quantification of EEG power and renormalized partial directed coherence for analysis of directed functional connectivity. Delirious subjects exhibited pronounced EEG slowing as well as severe general loss of directed functional connectivity between recording sites. Distinction between groups based on these parameters was surprisingly clear given the low sample size employed. Furthermore, by targeting the electrode positions where effects were most apparent it was possible to clearly segregate patients using only 3 scalp electrodes. These findings indicate that quantitative diagnosis and monitoring of delirium is not only possible using emerging QEEG methods but is also accomplishable using very low-density electrode systems.

SUBMITTER: Hunter A

PROVIDER: S-EPMC7242058 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Delirium screening in the intensive care unit using emerging QEEG techniques: A pilot study.

Hunter Andrew A Crouch Barry B Webster Nigel N Platt Bettina B

AIMS neuroscience 20200113 1

Delirium is an under-diagnosed yet frequently occurring clinical complication with potentially serious consequences for intensive care unit (ICU) patients. Diagnosis is currently reactive and based upon qualitative assessment of the patient's cognitive status by ICU staff. Here, we conducted a preliminary investigation into whether emerging quantitative electroencephalography (QEEG) analysis techniques can accurately discriminate between delirious and non-delirious patients in an ICU setting. Re ...[more]

PMID: 32455162

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Project description:BACKGROUND:Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation. METHODS:This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h. RESULTS:In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71-0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66-0.71)) (z score of -?2.73 (p?<?0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n?=?68) rated the E-PRE-DELIRIC model more feasible. CONCLUSIONS:While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02518646 . Registered on 21 July 2015.

Project description:BACKGROUND:Patients in the intensive care unit (ICU) are known to be at increased risk of developing delirium, but the risk of subsequent neuropsychiatric disorders is unclear. We therefore sought to examine the association between the presence of delirium in the ICU and incident neuropsychiatric disorders (including depressive, anxiety, trauma-and-stressor-related, and neurocognitive disorders) post-ICU stay among adult medical-surgical ICU patients. METHODS:Retrospective cohort study utilizing clinical and administrative data from both inpatient and outpatient healthcare visits to identify the ICU cohort and diagnostic information 5 years prior to and 1 year post-ICU stay. Patients ??18?years of age admitted to one of 14 medical-surgical ICUs across Alberta, Canada, January 1, 2014-June 30, 2016, and survived to hospital discharge were included. The main outcome of interest was a new diagnosis of any neuropsychiatric disorder 1 year post-ICU stay. The exposure variable was delirium during the ICU stay identified through any positive delirium screen by the Intensive Care Unit Delirium Screening Checklist (ICDSC) during the ICU stay. RESULTS:Of 16,005 unique patients with at least one ICU admission, 4033 patients were included in the study of which 1792 (44%) experienced delirium during their ICU stay. The overall cumulative incidence of any neuropsychiatric disorder during the subsequent year was 19.7% for ICU patients. After adjusting for hospital characteristics using log-binomial regression, patients with delirium during the ICU stay had a risk ratio (RR) of 1.14 (95% confidence interval [CI] 0.98-1.33) of developing any neuropsychiatric disorder within 1 year post-ICU compared to those who did not experience delirium. Delirium was significantly associated with neurocognitive disorders (RR 1.59, 95% CI 1.08-2.35), but not depressive disorders (RR 1.16, 95% CI 0.92-1.45), anxiety (RR 1.16, 95% CI 0.92-1.47), and trauma-and-stressor-related (RR 0.82, 95% CI 0.53-1.28) disorders. CONCLUSIONS:The diagnosis of new onset of neurocognitive disorders is associated with ICU-acquired delirium. In this study, significant associations were not observed for depressive, anxiety, and trauma-and-stressor-related disorders.

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Delirium screening in the intensive care unit using emerging QEEG techniques: A pilot study.

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Delirium screening in the intensive care unit using emerging QEEG techniques: A pilot study.

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