DeltaScan for the Assessment of Acute Encephalopathy and Delirium in ICU and non-ICU Patients, a Prospective Cross-Sectional Multicenter Validation Study
Ditzel, Fienke L; Hut, Suzanne C A; van den Boogaard, Mark; Boonstra, Michel; Leijten, Frans S S; Wils, Evert-Jan; van Nesselrooij, Tim; Kromkamp, Marjan; Rood, Paul J T; Röder, Christian; Bouvy, Paul F; Coesmans, Michiel; Osse, Robert Jan; Pop-Purceleanu, Monica; van Dellen, Edwin; Krulder, Jaap W M; Milisen, Koen; Faaij, Richard; Vondeling, Ariël M; Kamper, Ad M; van Munster, Barbara C; de Jonghe, Annemarieke; Winters, Marian A M; van der Ploeg, Jeanette; van der Zwaag, Sanneke; Koek, Dineke H L; Drenth-van Maanen, Clara A C; Beishuizen, Albertus; van den Bos, Deirdre M; Cahn, Wiepke; Schuit, Ewoud; Slooter, Arjen J C
(2024) The American Journal of Geriatric Psychiatry, volume 32, issue 9, pp. 1093 - 1104
(Article)
Abstract
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
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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.
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Keywords: Acute encephalopathy, Delirium, EEG, Polymorphic delta activity, Geriatrics and Gerontology, Psychiatry and Mental health, Journal Article
ISSN: 1064-7481
Publisher: Lippincott Williams & Wilkins
Note: Publisher Copyright: © 2023 The Authors
(Peer reviewed)