Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMJ Open. 2022 Jun 21;12(6):e057890. doi: 10.1136/bmjopen-2021-057890.
To internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.
A prospective, observational, multicentre study.
Three university-affiliated teaching hospitals in Thailand.
Adults aged over 18 years were enrolled if they were admitted to a surgical ICU (SICU) and had the surgery within 7 days before SICU admission.
Postoperative delirium was assessed using the Thai version of the Confusion Assessment Method for the ICU. The assessments commenced on the first day after the patient's operation and continued for 7 days, or until either discharge from the ICU or the death of the patient. Validation was performed of the previously developed delirium predictive model: age+(5×SOFA)+(15×benzodiazepine use)+(20×DM)+(20×mechanical ventilation)+(20×modified IQCODE>3.42).
In all, 380 SICU patients were recruited. Internal validation on 150 patients with the mean age of 75±7.5 years resulted in an area under a receiver operating characteristic curve (AUROC) of 0.76 (0.683 to 0.837). External validation on 230 patients with the mean age of 57±17.3 years resulted in an AUROC of 0.85 (0.789 to 0.906). The AUROC of all validation cohorts was 0.83 (0.785 to 0.872). The optimum cut-off value to discriminate between a high and low probability of postoperative delirium in SICU patients was 115. This cut-off offered the highest value for Youden's index (0.50), the best AUROC, and the optimum values for sensitivity (78.9%) and specificity (70.9%).
The model developed by the previous study was able to predict the occurrence of postoperative delirium in critically ill surgical patients admitted to SICUs.
Thai Clinical Trail Registry (TCTR20180105001).
对内外部验证一种适用于术后入住重症监护病房（ICU）的成年患者的谵妄预测模型。
前瞻性、观察性、多中心研究。
泰国的三家大学附属教学医院。
如果患者年龄超过 18 岁，且在入住 SICU 前 7 天内接受过手术，则将其纳入研究。
术后谵妄使用 ICU 版意识模糊评估法（CAM-ICU）进行评估。评估于患者手术后的第一天开始，并持续进行 7 天，或直至患者从 ICU 出院或死亡。对先前开发的谵妄预测模型进行验证：年龄+(5×SOFA)+(15×苯二氮䓬类药物使用)+(20×DM)+(20×机械通气)+(20×改良 IQCODE>3.42)。
共纳入 380 名 SICU 患者。对 150 名平均年龄为 75±7.5 岁的患者进行内部验证，得到的受试者工作特征曲线下面积（AUROC）为 0.76（0.683 至 0.837）。对 230 名平均年龄为 57±17.3 岁的患者进行外部验证，得到的 AUROC 为 0.85（0.789 至 0.906）。所有验证队列的 AUROC 为 0.83（0.785 至 0.872）。区分 SICU 患者术后谵妄发生高概率和低概率的最佳截断值为 115。该截断值提供了最高的 Youden 指数（0.50）值、最佳的 AUROC 值，以及最佳的敏感度（78.9%）和特异度（70.9%）值。
先前研究开发的模型能够预测入住 SICU 的重症手术患者术后发生谵妄的情况。
泰国临床试验注册中心（TCTR20180105001）。
