• Research

    Relevant publications relating to DeltaScan

    Breakthroughs in delirium research

    The severity of acute encephalopathy and delirium is increasingly recognised. This is reflected in the enormous increase in the number of publications on this topic. Only 10 articles about delirium were published in 1995, compared to more than 250 articles in 2015. We developed DeltaScan to meet the obvious need for improved and early detection of delirium. Listed below are several publications that encouraged us to get a better grip on delirium.

    In 2010, Heymann (Germany) demonstrated that treating delirium too late results in worse outcomes for the patient[1]. In 2011, Leslie and Inouye (USA) determined that the healthcare costs attributable to delirium are so high that they are ranked between the costs for diabetes and cardiovascular diseases[2]. In 2013, Pandharipande, Ely et al. (USA) demonstrated that a longer duration of delirium is associated with more significant long-term cognitive deterioration[3]. Ely[4] and later Pisani[5] demonstrated that each day that delirium persists is independently associated with an increase in the mortality risk by 10%.

    Slooter (NL) has demonstrated that delirium results in worse outcomes in many cases and that this deterioration is independent of the severity of the underlying disease[6]. As it became increasingly clear how severe delirium actually is, various groups of scientists started searching for ways to recognise delirium in an early stage. As early as 2001, Marcantonio (USA) and others had determined that intensive screening by geriatric specialists can limit the burden of delirium[7]. However, Slooter (NL) and others demonstrated in 2011 that the screening instruments currently in use in daily practice in the intensive care units have a poor sensitivity (47%)[8].

    A large meta-analysis by Marcantonio (USA) in 2017 concluded that up to 75% of the patients had a hypo-active or silent delirium and that only 12% to 35% of delirium patients are diagnosed. The patients that do receive a diagnosis are mainly those with hyperactive delirium [9]. Inouye et al. (USA) described in 2014 that suffering from delirium not only contributes to a higher risk of mortality, but also to an increased risk of admission to a nursing home due to loss of ADL functionalities [10].

    In 2010, Martin et al. (USA) studied the relationship between delirium and (post-operative) sepsis, in which they stated that delirium is an independent predictor of sepsis [11]. Van den Boogaard et al. (NL) demonstrated that the cognitive problems following hospitalisation were significantly higher in patients who had suffered delirium, compared to patients without delirium [12]. Mulkey et al. (USA) recently described the use of EEG in the detection of delirium, stating that EEG – with use of the latest techniques – allows for earlier and improved detection of delirium [13].

    Research within UMC Utrecht
    that resulted in DeltaScan

    EEG-registration without delirium

    EEG-registration with delirium

    The international guidelines are unambiguous

    Every single guideline states that there is a need for improved and early detection of delirium.

    “Considering the enormous burden that post-operative delirium imposes on patients, their loved ones, healthcare organisations and public resources, the anaesthesiologists employed in Europe should make every effort to establish integrated measures to reduce the incidence and duration of post-operative delirium.”

    “Early diagnosis of post-operative delirium is vital in facilitating targeted and effective treatment.”

    “Due to the fluctuating nature of post-operative delirium, staff in the recovery room should screen patients for post-operative delirium at least once per shift.”

    “Figures show that delirium remains undiagnosed in more than half of all cases.”

    “Delayed treatment appears to result in a prolonged duration of the delirium, which in turn is associated with a deterioration in cognitive and functional recovery and with an increase in morbidity and mortality amongst hospitalised patients.”

    “Compared to patients of the same age without delirium, patients with delirium have an increased mortality risk, a longer hospitalisation period, a higher risk of falling, a higher risk of becoming more dependent on care after discharge and a higher risk of developing dementia.”

    “Although delirium is a common condition, its detection leaves much to be desired and many cases are missed.”

    “Rapid diagnosis & timely treatment of underlying causes are important factors in limiting the severity and the duration of delirium and in reducing the risk of complications.”

    “[Delirium] is a serious condition that is associated with unfavourable outcomes. However, with timely intervention, this condition can be prevented and treated.”

    “Despite the negative prognostic implications of suffering delirium, most hospitals do not pay sufficient attention to the occurrence of delirium… Research indicates that delirium is not recognised in two thirds of patients.”

    “Early diagnosis [of delirium] can result in rapid identification and (if possible) correction of the etiology, reassurance of patients who experience frightening symptoms, (drug and non-drug) treatment and evaluation of the efficacy of the treatment.”

    “Delayed treatment appears to result in a prolonged duration of the delirium, which in turn is associated with a deterioration in cognitive and functional recovery and with an increase in morbidity and mortality amongst hospitalised patients.”

    Systematic screening for pain, degree of sedation and delirium and use of targeted sedation, analgesia and delirium protocols have been linked to a lower incidence of nosocomial infections, shorter ventilation times, shorter ICU admission, lower mortality and savings on resources.”

    “Screening for delirium should be performed regularly (every 8 hours) and the results should be documented.”

    Page 153:

    “Post-operative delirium can have detrimental consequences, such as delayed mobilisation, prolonged treatment, prolonged hospitalisation and obstruction of early rehabilitation. There are various diagnostic instruments that healthcare providers can use to assess their patients effectively and uniformly. Healthcare organisations should consider the use of such an instrument.”

    Delirium that is diagnosed early enough can be treated

    There are clear recommendations about how delirium should be treated. These recommendations are included in the following guidelines:

    • “Clinical Practice Guideline for Postoperative Delirium in Older Adults” by the American Geriatrics Society (USA, 2014);
    • “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU” by the Society of Critical Care Medicine (USA, 2018);
    • “Delirium: prevention, diagnosis and management” by the National Institute for Health and Care Excellence (NICE) (United Kingdom, 2019).

    DeltaScan® is an EU registered trademark (Certificate Nr 018280613) Version 2.0

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