Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, Gainesville, FL, United States of America.
Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States of America.
PLoS One. 2023 Aug 17;18(8):e0285527. doi: 10.1371/journal.pone.0285527. eCollection 2023.
The purpose of this systematic review was to assess risk of bias in existing prognostic models of hospital-induced delirium for medical-surgical units.
APA PsycInfo, CINAHL, MEDLINE, and Web of Science Core Collection were searched on July 8, 2022, to identify original studies which developed and validated prognostic models of hospital-induced delirium for adult patients who were hospitalized in medical-surgical units. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies was used for data extraction. The Prediction Model Risk of Bias Assessment Tool was used to assess risk of bias. Risk of bias was assessed across four domains: participants, predictors, outcome, and analysis.
Thirteen studies were included in the qualitative synthesis, including ten model development and validation studies and three model validation only studies. The methods in all of the studies were rated to be at high overall risk of bias. The methods of statistical analysis were the greatest source of bias. External validity of models in the included studies was tested at low levels of transportability.
Our findings highlight the ongoing scientific challenge of developing a valid prognostic model of hospital-induced delirium for medical-surgical units to tailor preventive interventions to patients who are at high risk of this iatrogenic condition. With limited knowledge about generalizable prognosis of hospital-induced delirium in medical-surgical units, existing prognostic models should be used with caution when creating clinical practice policies. Future research protocols must include robust study designs which take into account the perspectives of clinicians to identify and validate risk factors of hospital-induced delirium for accurate and generalizable prognosis in medical-surgical units.
本系统评价的目的是评估现有的用于医疗外科单位的医院诱导性谵妄预后模型的偏倚风险。
于 2022 年 7 月 8 日在 APA PsycInfo、CINAHL、MEDLINE 和 Web of Science Core Collection 上进行了检索，以确定用于医疗外科单位住院成人患者的医院诱导性谵妄预后模型的原始研究。使用预测模型系统评价的关键评估和数据提取清单进行数据提取。使用预测模型偏倚风险评估工具来评估偏倚风险。偏倚风险在四个领域进行评估：参与者、预测因素、结局和分析。
纳入了 13 项定性综合研究，包括 10 项模型开发和验证研究以及 3 项仅模型验证研究。所有研究的方法均被评为总体偏倚风险高。统计分析方法是偏倚的最大来源。纳入研究中模型的外部有效性在可转移性方面测试水平较低。
我们的研究结果强调了在医疗外科单位开发有效的医院诱导性谵妄预后模型以针对这种医源性疾病高风险患者定制预防干预措施的持续科学挑战。由于对医疗外科单位医院诱导性谵妄的普遍预后知之甚少，因此在制定临床实践政策时应谨慎使用现有的预后模型。未来的研究方案必须包括稳健的研究设计，考虑到临床医生的观点，以识别和验证医院诱导性谵妄的风险因素，从而在医疗外科单位实现准确和普遍的预后。
