Research

There have been various publications on the clinical validation and technology development of DeltaScan. Relevant references can be found on this page.

Relevant Publications for DeltaScan

Our suggested literature:

    Breakthroughs in delirium research

    The seriousness of delirium is progressively acknowledged. A dramatic 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, led us to develop DeltaScan.

    The following publications gave us the drive to tackle delirium and develop DeltaScan:

    In 2010, Heymann (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 et al (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 the underlying condition[6]. As the seriousness of the condition became more apparent, scientists worked in parallel on a means for early detection. Already in 2001, Marcantonio (USA) et al showed that intensive screening by geriatricians can result in a reduced burden of delirium[7]. However, in 2011, Slooter (NL) et al showed poor sensitivity (47%) of currently used delirium screening tools in routine ICU care[8].

    In 2010, Martin et al (US) in their study pointed to a relationship between delirium and (post-operative) sepsis, stating that delirium is an independent predictor of sepsis [11]. Van den Boogaard et al. (NL) have shown that cognitive problems after hospitalisation are significantly higher in patients who have had delirium, compared to patients without delirium [12]. Mulkey et al. (US) recently published the value of using EEG in the detection of delirium, stating that EEG, based on the latest techniques, can detect delirium earlier and more frequently[13].

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    [1] Heymann et al, 2010, J Int Med Res

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    [2] Leslie and Inouye, 2011, JAGS

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    [3] Pandharipande, et al., 2013, NEJM

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    [4] Ely et al, 2004, JAMA

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    [5] Pisani et al, 2009, AJRCCM

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    [6] Slooter, 2013,Nat Rev Neurol

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    [7] Marcantonio et al., 2001, JAGS

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    [8] Slooter et al., 2011, AJRCCM

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    [9] Marcantonio, 2017, NEJM

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    [10] Inouye et al., 2014, Lancet

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    [11] Martin et al., 2010, Crit Care

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    [12] Van Den Boogaard, 2012, Crit Care Med

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    [13] Mulkey et al., 2019, Dimens Crit Care Nurs

    Research at UMC Utrecht leading up to DeltaScan:

    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 Postoperative Delirium, 2017

    “Given the enormous burden exerted by POD on patients, their families, healthcare organizations and public resources, anesthesiologists 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 recognized, 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.” (page 79)

    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.” (page 153)

    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).

    Revision number: 1.1

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