Delirium detection using relative delta power based on 1-minute single-channel EEG: a multicentre study
T Numan, M van den Boogaard, A M Kamper, P J T Rood, L M Peelen, A J C Slooter, Dutch Delirium Detection Study Group, Masieh Abawi, Mark van den Boogaard, Jurgen Ahr Claassen, Michael Coesmans, Paul Dautzenberg, Ton Adf Dhondt, Shiraz B Diraoui, Piet Eikelenboom, Marielle H Emmelot-Vonk, Richard A Faaij, Willem A van Gool, Erwin R Groot, Carla Hagestein-de Bruijn, Jacqueline Gfm Hovens, Mathieu van der Jagt, Anne-Marieke de Jonghe, Adriaan M Kamper, Huiberdine L Koek, Arendina W van der Kooi, Marjan Kromkamp, Joep Lagro, Albert Fg Leentjens, Geert J Lefeber, Frans S Leijten, Carsten Leue, Tjarda de Man, Robert J van Marum, Roos C van der Mast, Barbara C van Munster, Tianne Numan, Robert Jan Osse, C Barbara Portier, Nathaly Rius Ottenheim, Paul Jt Rood, Christian H Röder, Yvonne Schoon, Arjen Jc Slooter, Arjen Tromp, Joris B van der Vlugt, Ariël M Vondeling, Annelies Wassenaar, Henry Weinstein, Joost Witlox, Jeroen S van Zanten, Philip M Zeman, Sanneke van der Zwaag, T Numan, M van den Boogaard, A M Kamper, P J T Rood, L M Peelen, A J C Slooter, Dutch Delirium Detection Study Group, Masieh Abawi, Mark van den Boogaard, Jurgen Ahr Claassen, Michael Coesmans, Paul Dautzenberg, Ton Adf Dhondt, Shiraz B Diraoui, Piet Eikelenboom, Marielle H Emmelot-Vonk, Richard A Faaij, Willem A van Gool, Erwin R Groot, Carla Hagestein-de Bruijn, Jacqueline Gfm Hovens, Mathieu van der Jagt, Anne-Marieke de Jonghe, Adriaan M Kamper, Huiberdine L Koek, Arendina W van der Kooi, Marjan Kromkamp, Joep Lagro, Albert Fg Leentjens, Geert J Lefeber, Frans S Leijten, Carsten Leue, Tjarda de Man, Robert J van Marum, Roos C van der Mast, Barbara C van Munster, Tianne Numan, Robert Jan Osse, C Barbara Portier, Nathaly Rius Ottenheim, Paul Jt Rood, Christian H Röder, Yvonne Schoon, Arjen Jc Slooter, Arjen Tromp, Joris B van der Vlugt, Ariël M Vondeling, Annelies Wassenaar, Henry Weinstein, Joost Witlox, Jeroen S van Zanten, Philip M Zeman, Sanneke van der Zwaag
Abstract
Background: Delirium is frequently unrecognised. EEG shows slower frequencies (i.e. below 4 Hz) during delirium, which might be useful in improving delirium recognition. We studied the discriminative performance of a brief single-channel EEG recording for delirium detection in an independent cohort of patients.
Methods: In this prospective, multicentre study, postoperative patients aged ≥60 yr were included (n=159). Before operation and during the first 3 postoperative days, patients underwent a 5-min EEG recording, followed by a video-recorded standardised cognitive assessment. Two or, in case of disagreement, three delirium experts classified each postoperative day based on the video and chart review. Relative delta power (1-4 Hz) was based on 1-min artifact-free EEG. The diagnostic value of the relative delta power was evaluated by the area under the receiver operating characteristic curve (AUROC), using the expert classification as the gold standard.
Results: Experts classified 84 (23.3%) postoperative days as either delirium or possible delirium, and 276 (76.7%) non-delirium days. The AUROC of the relative EEG delta power was 0.75 [95% confidence interval (CI) 0.69-0.82]. Exploratory analysis showed that relative power from 1 to 6 Hz had significantly higher AUROC (0.78, 95% CI 0.72-0.84, P=0.014).
Conclusions: Delirium/possible delirium can be detected in older postoperative patients based on a single-channel EEG recording that can be automatically analysed. This objective detection method with a continuous scale instead of a dichotomised outcome is a promising approach for routine detection of delirium.
Clinical trial registration: NCT02404181.
Keywords: complications, postoperative; delirium; electroencephalography; intensive care unit; monitoring; postoperative care.
Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Source: PubMed