Clinical validation and technology development of our products has been published. Relevant references can be found on this page.
Relevant Publications for DeltaScan
Our suggested literature:
- In 2009, van Eijk, Slooter and others published that delirium is underdiagnosed particularly its hypoactive forms. van Eijk, M., Marum, R., Klijn, A., de Wit, N., Kesecioglu, J., Slooter, A.J. Comparison of delirium assessment tools in a mixed intensive care unit. Critical Care Medicine. 37(6):1881-1885, JUN 2009.
- In 2011, van Eijck, Slooter and others published an article on the performance of currently used delirium screening tools in routine, daily practice. The results showed a poor sensitivity of 47%. Sensitivity for the most prevalent form, hypoactive delirium was merely 31%. This resulted in further studies aiming to develop an objective tool for monitoring of delirium. Boogaard, M. van den, van Eijk, M., Eikelenboom, P., van Matrum, R., Benner, P., & Honing, M. (2011). Routine use of the confusion assessment method for the intensive care unit. American Journal of Respiratory Critical Care Care Medicine, 184(3), 340-344.
- In 2015, Kooi, Slooter and others demonstrated the core principle of the EEG-based Delirium Monitor technology. Van Der Kooi, A.W., I. J., Klijn, F.A., Koek, H.L., Meijer, R. C., Leijten, F. S., & Slooter, A. J. (2015). Delirium detection using EEG: what and how to measure. CHEST Journal, 147(1), 94-101.
- In 2017, Numan and others published a study, that showed the difficulty of delirium diagnosis. In 21% of the cases the experts, the Gold Standard for delirium diagnosis, disagreed. Merely 32% of the actual delirium cases were reported in the nursing files, indicating under-detection of delirium in clinical practice. There is a clear need for an easy-to-use, reliable method of detecting delirium in clinical practice. Bipolar EEG may be a candidate for objective delirium detection. Numan, T., Boogaard, M. van den, Kamper, A.M., Rood, P. J., Peelen, L. M., & Slooter, A. J. (2017). Recognition of Delirium in Postoperative Elderly Patients: A Multicenter Study. Journal of the American Geriatrics Society.
- In 2018, Numan and others published findings that show that delirium can be detected in older postoperative patients using a 1 minute single-channel EEG recording analysed automatically. This method could enable objective detection of delirium, providing a continuous scale instead of a dichotomised outcome. Numan, T., Boogaard, M. van den, Kamper, A.M., Rood, P. J., Peelen, L. M., & Slooter, A. J. (2018). Delirium detection using relative delta power based on 1 minute single-channel EEG: a Multicenter Study. British Journal of Anaesthesia.
- In 2019, Kimchi and colleagues showed that clinical EEG slowing was related to delirium severity and predicts poor clinical outcomes such as longer hospitalizations, worse functional outcomes, and increased mortality. Kimchi E.Y., Neelagiri A., Whitt W., Rao A.S., Ryan, S.L., Gadbois, G., Groothuysen, D., Westover, M.B., (2019). Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes.
Breakthroughs 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 encourage us, to get a grip on delirium:
In 2010, Heymann (Germany) showed that delayed treatment of delirium impairs patient outcomes. In 2011, Leslie and Inouye (USA) showed  that delirium-attributed healthcare costs rank between the costs for diabetes and those of cardiovascular disease. In 2013, Pandharipande, Ely and others (USA) showed  that a longer duration of a delirium episode worsens long-term cognitive impairment. Ely, and later Pisani, 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. 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. However, in 2011, Slooter (NL) and others showed poor sensitivity (47%) of currently used delirium screening tools in routine ICU care.
 Heymann et al, 2010, J Int Med Res
 Leslie and Inouye, 2011, JAGS
 Pandharipande, et al., 2013, NEJM
 Ely et al, 2004, JAMA
 Pisani et al, 2009, AJRCCM
 Slooter, 2013,Nat Rev Neurol
 Marcantonio et al., 2001, JAGS
 Slooter et al., 2011, AJRCCM
Research at UMC Utrecht leading up to DeltaScan:
- In 2017, Numan published her PhD thesis, titled “EEG in delirium”
Numan, T. (2017) “EEG in delirium” (Doctoral dissertation, Utrecht University).
- In 2014, van der Kooi published her PhD thesis which focuses on characterizing the neurophysiology of delirium and to assess whether alternations in the neurophysiology of delirium could provide opportunities for delirium detection.
van der Kooi, A. W. (2014) “Neurophysiology of delirium” (Doctoral dissertation, Utrecht University).
EEG without delirium
EEG with delirium
International delirium guidelines are unanimous
They all describe a need for improved and early delirium detection
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.”
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, Delirium: prevention, diagnosis and management guideline, 2019
“It (delirium, red.) is a serious condition that is associated with poor outcomes. However, it can be prevented and treated if dealt with urgently”
the Netherlands: the Dutch Health Inspectorate annual report “Quality Indicators – Basic Hospital Set”, 2016
“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: Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, 2018
“Early detection (of delirium, red.) may lead to prompt identification and correction (when possible) of etiology, assurance of patients experiencing distressing symptoms, treatment (pharmacologic or nonpharmacologic), and treatment effectiveness assessments.”
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.”
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.”
USA, Joint Commission International, Safe surgery guide
“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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