Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.

Several risk stratification instruments for postoperative delirium in older people have been developed because early interventions may prevent delirium. We investigated the performance and agreement of nine commonly used risk stratification instruments in an independent validation cohort of consecut...

Full description

Bibliographic Details
Main Authors: Carolien J Jansen, Anthony R Absalom, Geertruida H de Bock, Barbara L van Leeuwen, Gerbrand J Izaks
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2014-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0113946
id doaj-cda8962e2adf45279f88b9b1f82507a6
record_format Article
spelling doaj-cda8962e2adf45279f88b9b1f82507a62021-03-04T08:43:11ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01912e11394610.1371/journal.pone.0113946Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.Carolien J JansenAnthony R AbsalomGeertruida H de BockBarbara L van LeeuwenGerbrand J IzaksSeveral risk stratification instruments for postoperative delirium in older people have been developed because early interventions may prevent delirium. We investigated the performance and agreement of nine commonly used risk stratification instruments in an independent validation cohort of consecutive elective and emergency surgical patients aged ≥50 years with ≥1 risk factor for postoperative delirium. Data was collected prospectively. Delirium was diagnosed according to DSM-IV-TR criteria. The observed incidence of postoperative delirium was calculated per risk score per risk stratification instrument. In addition, the risk stratification instruments were compared in terms of area under the receiver operating characteristic (ROC) curve (AUC), and positive and negative predictive value. Finally, the positive agreement between the risk stratification instruments was calculated. When data required for an exact implementation of the original risk stratification instruments was not available, we used alternative data that was comparable. The study population included 292 patients: 60% men; mean age (SD), 66 (8) years; 90% elective surgery. The incidence of postoperative delirium was 9%. The maximum observed incidence per risk score was 50% (95%CI, 15-85%); for eight risk stratification instruments, the maximum observed incidence per risk score was ≤25%. The AUC (95%CI) for the risk stratification instruments varied between 0.50 (0.36-0.64) and 0.66 (0.48-0.83). No AUC was statistically significant from 0.50 (p≥0.11). Positive predictive values of the risk stratification instruments varied between 0-25%, negative predictive values between 89-95%. Positive agreement varied between 0-66%. No risk stratification instrument showed clearly superior performance. In conclusion, in this independent validation cohort, the performance and agreement of commonly used risk stratification instruments for postoperative delirium was poor. Although some caution is needed because the risk stratification instruments were not implemented exactly as described in the original studies, we think that their usefulness in clinical practice can be questioned.https://doi.org/10.1371/journal.pone.0113946
collection DOAJ
language English
format Article
sources DOAJ
author Carolien J Jansen
Anthony R Absalom
Geertruida H de Bock
Barbara L van Leeuwen
Gerbrand J Izaks
spellingShingle Carolien J Jansen
Anthony R Absalom
Geertruida H de Bock
Barbara L van Leeuwen
Gerbrand J Izaks
Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
PLoS ONE
author_facet Carolien J Jansen
Anthony R Absalom
Geertruida H de Bock
Barbara L van Leeuwen
Gerbrand J Izaks
author_sort Carolien J Jansen
title Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
title_short Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
title_full Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
title_fullStr Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
title_full_unstemmed Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
title_sort performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2014-01-01
description Several risk stratification instruments for postoperative delirium in older people have been developed because early interventions may prevent delirium. We investigated the performance and agreement of nine commonly used risk stratification instruments in an independent validation cohort of consecutive elective and emergency surgical patients aged ≥50 years with ≥1 risk factor for postoperative delirium. Data was collected prospectively. Delirium was diagnosed according to DSM-IV-TR criteria. The observed incidence of postoperative delirium was calculated per risk score per risk stratification instrument. In addition, the risk stratification instruments were compared in terms of area under the receiver operating characteristic (ROC) curve (AUC), and positive and negative predictive value. Finally, the positive agreement between the risk stratification instruments was calculated. When data required for an exact implementation of the original risk stratification instruments was not available, we used alternative data that was comparable. The study population included 292 patients: 60% men; mean age (SD), 66 (8) years; 90% elective surgery. The incidence of postoperative delirium was 9%. The maximum observed incidence per risk score was 50% (95%CI, 15-85%); for eight risk stratification instruments, the maximum observed incidence per risk score was ≤25%. The AUC (95%CI) for the risk stratification instruments varied between 0.50 (0.36-0.64) and 0.66 (0.48-0.83). No AUC was statistically significant from 0.50 (p≥0.11). Positive predictive values of the risk stratification instruments varied between 0-25%, negative predictive values between 89-95%. Positive agreement varied between 0-66%. No risk stratification instrument showed clearly superior performance. In conclusion, in this independent validation cohort, the performance and agreement of commonly used risk stratification instruments for postoperative delirium was poor. Although some caution is needed because the risk stratification instruments were not implemented exactly as described in the original studies, we think that their usefulness in clinical practice can be questioned.
url https://doi.org/10.1371/journal.pone.0113946
work_keys_str_mv AT carolienjjansen performanceandagreementofriskstratificationinstrumentsforpostoperativedeliriuminpersonsaged50yearsorolder
AT anthonyrabsalom performanceandagreementofriskstratificationinstrumentsforpostoperativedeliriuminpersonsaged50yearsorolder
AT geertruidahdebock performanceandagreementofriskstratificationinstrumentsforpostoperativedeliriuminpersonsaged50yearsorolder
AT barbaralvanleeuwen performanceandagreementofriskstratificationinstrumentsforpostoperativedeliriuminpersonsaged50yearsorolder
AT gerbrandjizaks performanceandagreementofriskstratificationinstrumentsforpostoperativedeliriuminpersonsaged50yearsorolder
_version_ 1714807719281557504