RESEARCH

Clinical validation and technology development of our products has been published. Relevant references can be found on this page.
 

Breakthrough in delirium research

The seriousness of delirium is progressively acknowledged. A drastic increase in scientific publications reflects this; in 1995 only 10 delirium articles were published, in 2015 over 250.

The clear medical need for improved and early delirium detection, made us develop DeltaScan. 

A few publications that encouraged us:
In 2010, Spies (Germany) showed that delayed treatment of delirium impairs patient outcomes.[1]
In 2011, Leslie and Inouye (USA) showed [2] that delirium-attributed healthcare costs rank between the costs for diabetes and those of cardiovascular disease. In 2013, Pandharipande, Ely and others (USA) showed [3] that a longer duration of a delirium episode worsens long-term cognitive impairment.
Ely,[4] and later Pisani,[5] showed that delirium is independently associated with a 10% higher chance of mortality per day of delirium.

Slooter (NL) showed that delirium causes impaired outcomes in many cases, independent of the severity of underlying disease.[6] As the seriousness of the condition became more apparent, scientists worked in parallel on means for early detection. Already in 2001, Marcantonio (USA) and others showed that intensive screening by geriatricians can result in a reduced burden of delirium.[7] However, in 2011, Slooter (NL) and others showed poor sensitivity (47%) of currently used delirium screening tools in routine ICU care.[8]

 

[1] Heymann et al, 2010, J Int Med Res
[2] Leslie and Inouye, 2011, JAGS
[3] Pandharipande, et al., 2013, NEJM
[4] Ely et al, 2004, JAMA
[5] Pisani et al, 2009, AJRCCM
[6] Slooter, 2013,Nat Rev Neurol
[7] Marcantonio et al., 2001, JAGS
[8] Slooter et al., 2011, AJRCCM

 

Suggested Literature

Relevant publications for DeltaScan:

Research @ UMC Utrecht leading up to DeltaScan:

International delirium guidelines

the need for improved and early detection is crystal clear:

    • European Society of Anaesthesiology evidence-based and consensus-based Guideline on Post Operative Delirium, 2017:
      “Given the enormous burden exerted by POD on patients, their families, healthcare organisations and public resources, anaesthesiologists operating in Europe should engage to make efforts in designing integrated actions aimed to reduce the incidence and duration of POD.”
      “Early diagnosis of POD is critical to trigger focused and effective treatment. “
      “On the postoperative ward, POD should be monitored at least once per shift due to the fluctuating course of POD.”
      “Delirium is reported to remain undiagnosed in more than half of cases.”
      “Delays to initiation of treatment have been found to result in prolongation of delirium, which is associated with worse cognitive and functional recovery, and  higher inpatient morbidity a mortality.”
    • USA: American Society of Critical Care Medicine guidelines for delirium, 2013:
      “Monitoring critically ill patients for delirium with valid and reliable delirium assessment tools enables clinicians to potentially detect and treat delirium sooner, and possibly improve outcomes.”
    • USA: American Geriatric Society Guideline on Postoperative Delirium, 2014:
      “Delays to initiation of treatment have been found to result in prolongation of delirium, which is associated with worse cognitive and functional recovery, and higher inpatient morbidity and mortality.”
    • Australia: Delirium clinical care standard, 2016:
      ” Compared with patients of the same age without delirium, patients with delirium have an increased risk of death, increased length of stay, increased risk of falls, a greater chance of being discharged to a higher dependency of care and a greater chance of developing dementia.”
      ” Despite being a common condition, delirium is poorly recognised and cases are often missed.”
      “Prompt diagnosis & timely treatment of underlying causes are important for reducing the severity and duration of delirium and risk of complications from it.”
    • UK: National Institute for Health and Care Excellence NICE guideline delirium, 2014:
      “Delirium is a serious condition that is associated with poor outcomes. However, it can be prevented and treated if dealt with urgently.”
    • Germany: S3-Leitlinie zu Analgesie, Sedierung und Delirmanagement in der Intensivmedizin, 2015:
      “The systemic monitoring of pain, sedation and delirium, targeted protocols for the management of sedation, analgesia and delirium are associated with lower incidence of nosocomial infections, a reduction in the duration of ventilation and length of ICU stay (LOS), lower mortality and lower resource consumption.”
      “Delirium monitoring should be performed regularly (8-hourly) and be documented.”

    • the Netherlands: the Dutch Health Inspectorate  annual report “Quality Indicators – Basic Hospital Set”, 2016, page 79:
      “Despite the negative prognostic implications of going through a delirium, in most hospitals little attention is paid to the occurrence of delirium …
      Research shows that delirium is not recognized in two-thirds of the patients.”
      the Netherlands: IGZ Kwaliteitsindicatoren, Basisset ziekenhuizen 2016, pag 79:
      “Ondanks de negatieve prognostische implicaties van het doormaken van een delirium wordt in de meeste ziekenhuizen weinig aandacht besteed aan het optreden van een delirium… Uit onderzoek is bekend dat het delirium bij tweederde van de patiënten niet herkend wordt.”
    • USA, Joint Commission International, Safe surgery guide, page 153:
      “Postoperative delirium can have negative effects, such as delaying postoperative movement, prolonging treatment, extending length of stay, and preventing early rehabilitation. There are several diagnostic tools available to help providers assess patients effectively and consistently. Organizations should consider using such a tool.”
If detected in time, delirium can be treated

There are clear guidelines on how to treat the condition, see for example the guidelines:

    • Postoperative delirium of the American Geriatric Society (USA, 2014)
    • Pain-Agitation-Delirium guidelines of the Society of Critical Care Medicine (USA, 2013).
    • Delirium: prevention, diagnosis and management’ of the National Institute for Health and Care Excellence NICE (UK, 2014).

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