TY - JOUR
T1 - DeltaScan for the Assessment of Acute Encephalopathy and Delirium in ICU and non-ICU Patients, a Prospective Cross-Sectional Multicenter Validation Study
AU - Ditzel, Fienke L.
AU - Hut, Suzanne C.A.
AU - van den Boogaard, Mark
AU - Boonstra, Michel
AU - Leijten, Frans S.S.
AU - Wils, Evert Jan
AU - van Nesselrooij, Tim
AU - Kromkamp, Marjan
AU - Rood, Paul J.T.
AU - Röder, Christian
AU - Bouvy, Paul F.
AU - Coesmans, Michiel
AU - Osse, Robert Jan
AU - Pop-Purceleanu, Monica
AU - van Dellen, Edwin
AU - Krulder, Jaap W.M.
AU - Milisen, Koen
AU - Faaij, Richard
AU - Vondeling, Ariël M.
AU - Kamper, Ad M.
AU - van Munster, Barbara C.
AU - de Jonghe, Annemarieke
AU - Winters, Marian A.M.
AU - van der Ploeg, Jeanette
AU - van der Zwaag, Sanneke
AU - Koek, Dineke H.L.
AU - Drenth-van Maanen, Clara A.C.
AU - Beishuizen, Albertus
AU - van den Bos, Deirdre M.
AU - Cahn, Wiepke
AU - Schuit, Ewoud
AU - Slooter, Arjen J.C.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2024
Y1 - 2024
N2 - Objectives: To measure the diagnostic accuracy of DeltaScan: a portable real-time brain state monitor for identifying delirium, a manifestation of acute encephalopathy (AE) detectable by polymorphic delta activity (PDA) in single-channel electroencephalograms (EEGs). Design: Prospective cross-sectional study. Setting: Six Intensive Care Units (ICU's) and 17 non-ICU departments, including a psychiatric department across 10 Dutch hospitals. Participants: 494 patients, median age 75 (IQR:64-87), 53% male, 46% in ICUs, 29% delirious. Measurements: DeltaScan recorded 4-minute EEGs, using an algorithm to select the first 96 seconds of artifact-free data for PDA detection. This algorithm was trained and calibrated on two independent datasets. Methods: Initial validation of the algorithm for AE involved comparing its output with an expert EEG panel's visual inspection. The primary objective was to assess DeltaScan's accuracy in identifying delirium against a delirium expert panel's consensus. Results: DeltaScan had a 99% success rate, rejecting 6 of the 494 EEG's due to artifacts. Performance showed and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.86 (95% CI: 0.83-0.90) for AE (sensitivity: 0.75, 95%CI=0.68-0.81, specificity: 0.87 95%CI=0.83-0.91. The AUC was 0.71 for delirium (95%CI=0.66-0.75, sensitivity: 0.61 95%CI=0.52-0.69, specificity: 72, 95%CI=0.67-0.77). Our validation aim was an NPV for delirium above 0.80 which proved to be 0.82 (95%CI: 0.77-0.86). Among 84 non-delirious psychiatric patients, DeltaScan differentiated delirium from other disorders with a 94% (95%CI: 87-98%) specificity. Conclusions: DeltaScan can diagnose AE at bedside and shows a clear relationship with clinical delirium. Further research is required to explore its role in predicting delirium-related outcomes.
AB - Objectives: To measure the diagnostic accuracy of DeltaScan: a portable real-time brain state monitor for identifying delirium, a manifestation of acute encephalopathy (AE) detectable by polymorphic delta activity (PDA) in single-channel electroencephalograms (EEGs). Design: Prospective cross-sectional study. Setting: Six Intensive Care Units (ICU's) and 17 non-ICU departments, including a psychiatric department across 10 Dutch hospitals. Participants: 494 patients, median age 75 (IQR:64-87), 53% male, 46% in ICUs, 29% delirious. Measurements: DeltaScan recorded 4-minute EEGs, using an algorithm to select the first 96 seconds of artifact-free data for PDA detection. This algorithm was trained and calibrated on two independent datasets. Methods: Initial validation of the algorithm for AE involved comparing its output with an expert EEG panel's visual inspection. The primary objective was to assess DeltaScan's accuracy in identifying delirium against a delirium expert panel's consensus. Results: DeltaScan had a 99% success rate, rejecting 6 of the 494 EEG's due to artifacts. Performance showed and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.86 (95% CI: 0.83-0.90) for AE (sensitivity: 0.75, 95%CI=0.68-0.81, specificity: 0.87 95%CI=0.83-0.91. The AUC was 0.71 for delirium (95%CI=0.66-0.75, sensitivity: 0.61 95%CI=0.52-0.69, specificity: 72, 95%CI=0.67-0.77). Our validation aim was an NPV for delirium above 0.80 which proved to be 0.82 (95%CI: 0.77-0.86). Among 84 non-delirious psychiatric patients, DeltaScan differentiated delirium from other disorders with a 94% (95%CI: 87-98%) specificity. Conclusions: DeltaScan can diagnose AE at bedside and shows a clear relationship with clinical delirium. Further research is required to explore its role in predicting delirium-related outcomes.
KW - Acute encephalopathy
KW - Delirium
KW - EEG
KW - Polymorphic delta activity
UR - http://www.scopus.com/inward/record.url?scp=85182454048&partnerID=8YFLogxK
U2 - 10.1016/j.jagp.2023.12.005
DO - 10.1016/j.jagp.2023.12.005
M3 - Article
C2 - 38171949
AN - SCOPUS:85182454048
SN - 1064-7481
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
ER -