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Acute Brain Dysfunction: Development and Validation of a Daily Prediction Model.

Annachiara Marra¹, Pratik P Pandharipande², Matthew S Shotwell³

¹Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, Naples, Italy.

|March 28, 2018

Summary

A new dynamic risk model predicts daily changes in acute brain dysfunction (delirium/coma), ICU discharge, and mortality. This validated model aids in predicting patient outcomes and improving ICU care delivery.

Keywords:

ICU coma delirium mortality prediction

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Area of Science:

Critical Care Medicine
Neurology
Health Informatics

Background:

Intensive Care Unit (ICU) patients face daily risks of acute brain dysfunction, including delirium and coma.
Predicting these outcomes, along with ICU discharge and mortality, is crucial for patient management.

Purpose of the Study:

To develop and validate a dynamic risk model for predicting daily changes in acute brain dysfunction, ICU discharge, and mortality in ICU patients.
To create a tool that estimates transition probabilities between different brain function states and outcomes.

Main Methods:

A multicenter prospective ICU cohort dataset was used.
Multinomial logistic regression developed the acute brain dysfunction-prediction model (ABD-pm), estimating 15 transition probabilities.
Internal validation employed a bootstrap procedure, assessing discrimination via Negative Predictive Value (NPV) and calibration.

Main Results:

The ABD-pm incorporated factors like mental status, age, cognitive impairment, illness severity, and sedative use.
The model achieved high NPVs for next-day delirium (0.823), coma (0.892), normal cognitive state (0.875), ICU discharge (0.905), and mortality (0.981).
Outstanding calibration was observed in predicting patient state distributions.

Conclusions:

A dynamic risk model (ABD-pm) was developed and validated to predict daily risks for cognitive states, ICU discharge, and mortality.
The ABD-pm can inform quality, safety, and care delivery by predicting patient outcomes across ICU populations.