Estimating patients’ risk for postoperative delirium from preoperative routine data - Trial design of the PRe-Operative prediction of postoperative DElirium by appropriate SCreening (PROPDESC) study - A monocentre prospective observational trial

Abstract

BackgroundPostoperative Delirium (POD) is the most common complication of elderly patients after surgery associated with increased postoperative morbidity, persistent care dependency and even mortality. Prevention of POD requires detection of patients at high risk prior to surgery. PROPDESC intends to provide an instrument for preoperative routine screening of patients' risk for POD.MethodsPROPDESC is a monocentric prospective observatory trial including 1000 patients older than 60 years from various disciplines of a university hospital planned for surgery of at least 60 min. To develop a score predicting the risk for POD, anesthesiological stratifications, laboratory values, medication and known risk factors as well as quality of life and cognitive performance are taken into account. POD assessment is performed daily on the first five days after the operation respectively the end of sedation in the intensive care units and normal wards. The score is evaluated from 600 data sets and subsequently validated internally. The most appropriate predictors are determined by a component-wise gradient boosting approach.DiscussionBased on retrospective investigations, etiology of POD is considered multifactorial. By a prospective analysis of various factors, PROPDESC intends to provide an applicable tool to predict the risk for POD from preoperative routine data and assessment of cognitive function. Objective is to establish an automatically generating score in preoperative routine to screen patients for increased risk of POD as starting point for POD reduction and management. Model compilation requires a high significance and enhancement within compound as well as regular availability of the selected predictors.Trial registrationDRKS, DRKS00015715. Registered 13 December 2018 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015715.

Perioperative Vascular Biomarker Profiling in Elective Surgery Patients Developing Postoperative Delirium: A Prospective Cohort Study

“…However, the primary goal of perioperative medicine should not only be survival but rather a favorable treatment outcome in terms of physical, as well as mental performance, particularly avoiding cognitive decline to preserve a satisfying quality of life. The single-center PROPDESC trial was designed to identify score-based parameters that allow estimation of the patients’ individual risk for POD development from preoperative routine data in a cohort of elective surgery patients aged >60 years [ 14 ]. The results of the herein presented analysis were obtained from a large subcohort of consecutively enrolled PROPDESC patients who underwent additional biomarker profiling to identify potential candidate markers that might help improve score-based screening [ 27 ].…”

“…The PRe-Operative Prediction of postoperative DElirium by appropriate SCreening (PROPDESC) trial is an investigator-initiated prospective monocentric observational study at the Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn. Details of the study design were previously described [ 14 ]. The trial was conducted in accordance with the Declaration of Helsinki and after approval by the institutional review board (IRB) of the University of Bonn (protocol number 255/17, date of approval 18 September 2017; Chairman—Professor K. Racké).…”

“…Therefore, we assessed a panel of 17 biomarkers characteristic for vascular activation and permeability and for systemic inflammation in serum samples from elective adult patients across all relevant types of surgery. Analyses were performed on a subcohort of the single-center PROPDESC trial [ 14 ].…”

Longitudinal validation of an electronic health record delirium prediction model applied at admission in COVID-19 patients

“…Although delirium is often underdiagnosed and under coded, electronic health records (EHR) data can be used to study both the epidemiology and biology of delirium [ [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] ]. Building on this potential, EHR data produced during routine care have been repurposed for secondary use in developing clinical prediction models of delirium risk [ [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ]. We previously reported the development and contemporaneous external validation of a machine learning model of delirium risk among patients with COVID-19 presenting during the spring of 2020 [ 68 ].…”

Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review

“…Its administration takes about two minutes and is accessible for clinical practice. It has been validated in different languages such as Danish (4), Turkish (5), Czech (6), and Korean (7), and used in different clinical practice scenarios: palliative care patients (8,9), cardiac surgery (10,11), liver transplantation (12), orthopedic surgery (13), urological surgery (14,15), scheduled post-operative patients (16)(17)(18)(19), post-anesthesia with medications such as ketamine (20), hospitalization (21), geriatrics hospitalization (22), oncologic hospitalization (23), and ICUs (24)(25)(26). The results of these studies report an average sensitivity of 96 % and specificity of 81 % using this scale.…”