ICU 中谵妄的预测：两种谵妄预测模型的比较。
Delirium prediction in the intensive care unit: comparison of two delirium prediction models.
机构信息
Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
Faculty of Health Sciences and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Southampton, UK.
出版信息
Crit Care. 2018 May 5;22(1):114. doi: 10.1186/s13054-018-2037-6.
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.
背景
在重症监护病房（ICU）中准确预测谵妄可以促进早期预防策略的有效利用，并在临床研究中对谵妄风险进行分层，但目前尚不清楚最佳的谵妄预测模型。我们比较了 ICU 患者的谵妄预测模型（PRE-DELIRIC）和早期谵妄预测模型（E-PRE-DELIRIC）的预测性能和用户便利性，并确定了两阶段计算的价值。
方法
这是一项在 7 个国家的 11 家医院进行的前瞻性队列研究，评估了能够使用 ICU 意识模糊评估法或重症监护谵妄筛查检查表可靠评估谵妄的连续成年 ICU 患者。使用接收者操作特征曲线下面积来衡量模型的预测性能。通过图形评估校准。一份医师问卷评估了用户便利性。对于两阶段计算，我们在 ICU 入院后立即使用 E-PRE-DELIRIC，并在 24 小时后使用 PRE-DELIRIC 更新预测。
结果
共纳入 2178 例患者。PRE-DELIRIC 的接收者操作特征曲线下面积显著大于 E-PRE-DELIRIC（0.74（95%置信区间 0.71-0.76）比 0.68（95%置信区间 0.66-0.71））（z 值为-2.73（p<0.01））。两种模型的校准都很好。在低危患者中，使用两阶段计算可以提高敏感性。与 PRE-DELIRIC 相比，ICU 医师（n=68）认为 E-PRE-DELIRIC 模型更可行。
结论
虽然两种 ICU 谵妄预测模型的性能均为中等至较好，但 PRE-DELIRIC 模型预测谵妄的效果更好。然而，ICU 医师认为 E-PRE-DELIRIC 模型比 PRE-DELIRIC 模型更便于使用。在低危患者中，在 24 小时后使用 PRE-DELIRIC 模型更新后，谵妄预测进一步提高。
试验注册
ClinicalTrials.gov，NCT02518646。注册于 2015 年 7 月 21 日。
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