Adelaars Sophie, Te Pas Mariska E, Jansen Steffy W M, van der Linden Carolien M J, Oosterbos Erwin, van de Kerkhof Daan, Buise Marc P, Bouwman R Arthur
Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven 5612 AE, the Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven 5623 EJ, the Netherlands; Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven 5623 EJ, the Netherlands.
Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven 5623 EJ, the Netherlands.
J Clin Anesth. 2025 Sep;106:111896. doi: 10.1016/j.jclinane.2025.111896. Epub 2025 Jun 18.
Postoperative delirium (POD) is a common complication after cardiac surgery, associated with increased morbidity, mortality, prolonged hospitalization, and cognitive decline. Early and accurate diagnosis is crucial, but current methods like the Delirium Observation Screening (DOS) scale rely on subjective assessments. Single‑lead EEG (sl-EEG), particularly the DeltaScan Brainstate Monitor, offers a more objective approach. This study compares the incidence of delirium detected by clinical observation, DOS scores, and single‑lead EEG scores in patients undergoing aortic valve replacement (AVR) surgery.
This prospective cohort study included 50 patients aged 65 or older scheduled for AVR surgery. Delirium was assessed preoperatively and on postoperative days 1, 3, and 7 using clinical observation, DOS, and single‑lead EEG. Incidence rates were calculated, and the McNemar's Chi-squared test was used to assess differences between methods.
Delirium incidence varied widely by method: 32 % by clinical assessment, 28 % by DOS, and 76 % by single‑lead EEG. Clinical assessment and DOS had an 80 % concordance, while single‑lead EEG detected significantly more cases (p < 0.001). Incidence declined across all methods over seven postoperative days.
Our findings reveal significant discrepancies in POD detection rates by diagnostic methods. The high sensitivity of sl-EEG suggests a risk of false positives, while clinical assessment and DOS may risk underdiagnosis, especially in hypoactive delirium. An integrated diagnostic approach combining multiple methods may improve accuracy and capture the full spectrum of delirium symptoms. Future studies should refine these tools and explore advanced technologies to develop reliable, easily deployable diagnostics for clinical practice.
术后谵妄（POD）是心脏手术后常见的并发症，与发病率增加、死亡率上升、住院时间延长及认知功能下降相关。早期准确诊断至关重要，但目前如谵妄观察筛查（DOS）量表等方法依赖主观评估。单导联脑电图（sl-EEG），尤其是DeltaScan脑状态监测仪，提供了一种更客观的方法。本研究比较了接受主动脉瓣置换（AVR）手术患者中通过临床观察、DOS评分和单导联脑电图评分检测到的谵妄发生率。
这项前瞻性队列研究纳入了50例年龄在65岁及以上计划接受AVR手术的患者。术前以及术后第1、3和7天使用临床观察、DOS和单导联脑电图对谵妄进行评估。计算发病率，并使用McNemar卡方检验评估不同方法之间的差异。
谵妄发生率因方法不同而有很大差异：临床评估为32%，DOS为28%，单导联脑电图为76%。临床评估和DOS的一致性为80%，而单导联脑电图检测到的病例明显更多（p<0.001）。术后7天内，所有方法的发病率均下降。
我们的研究结果揭示了不同诊断方法在POD检测率上存在显著差异。单导联脑电图的高敏感性提示存在假阳性风险，而临床评估和DOS可能存在漏诊风险，尤其是在活动减退型谵妄中。结合多种方法的综合诊断方法可能提高准确性并捕捉谵妄症状的全貌。未来的研究应改进这些工具并探索先进技术，以开发适用于临床实践的可靠、易于应用的诊断方法。
