Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; The Centre for Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of Excellence, China.
Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai 200032, China; Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Int J Nurs Stud. 2022 Dec;136:104340. doi: 10.1016/j.ijnurstu.2022.104340. Epub 2022 Aug 6.
Many studies have developed or validated prediction models to estimate the risk of delirium after cardiac surgery, but the quality of the model development and model applicability remain unknown.
To systematically review and critically evaluate currently available prediction models for delirium after cardiac surgery.
PubMed, EMBASE, and MEDLINE were systematically searched. This systematic review was registered in PROSPERO (Registration ID: CRD42021251226).
Prospective or retrospective cohort studies were considered eligible if they developed or validated prediction models or scoring systems for delirium in the ICU. We included studies involving adults (age ≥18 years) undergoing cardiac surgery and excluded studies that did not validate a prediction model.
Data extraction was independently performed by two authors using a standardized data extraction form based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist. Quality of the models was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST).
Of 5469 screened studies, 13 studies described 10 prediction models. The postoperative delirium incidence varied from 11.3 % to 51.6 %. The most frequently used predictors were age and cognitive impairment. The reported areas under the curve or C-statistics were between of 0.74 and 0.91 in the derivation set. The reported AUCs in the external validation set were between 0.54 and 0.90. All the studies had a high risk of bias, mainly owing to poor reporting of the outcome domain and analysis domain; 10 studies were of high concern regarding applicability.
The current models for predicting postoperative delirium in the ICU after cardiac surgery had a high risk of bias according to the PROBAST. Future studies should focus on improving current prediction models or developing new models with rigorous methodology.
许多研究已经开发或验证了预测模型来估计心脏手术后发生谵妄的风险，但模型开发的质量和模型适用性仍然未知。
系统地回顾和批判性评估目前可用于心脏手术后谵妄的预测模型。
系统地检索了 PubMed、EMBASE 和 MEDLINE。本系统评价在 PROSPERO（注册号：CRD42021251226）中进行了注册。
如果前瞻性或回顾性队列研究开发或验证了 ICU 中谵妄的预测模型或评分系统，则认为符合条件。我们纳入了涉及接受心脏手术的成年人（年龄≥18 岁）的研究，并排除了未验证预测模型的研究。
两名作者使用基于预测模型风险偏倚评估工具（PROBAST）的标准化数据提取表，独立进行数据提取。模型质量采用预测模型风险偏倚评估工具（PROBAST）进行评估。
在 5469 篇筛选研究中，有 13 篇研究描述了 10 个预测模型。术后谵妄发生率从 11.3%到 51.6%不等。最常用的预测因子是年龄和认知障碍。在推导组中报告的曲线下面积或 C 统计量在 0.74 到 0.91 之间。在外部验证组中报告的 AUC 介于 0.54 和 0.90 之间。所有研究的偏倚风险均较高，主要是由于结局和分析领域的报告较差；10 项研究的适用性问题值得关注。
根据 PROBAST，目前用于预测心脏手术后 ICU 中术后谵妄的模型存在较高的偏倚风险。未来的研究应侧重于改进现有的预测模型或使用严格的方法开发新的模型。
