E-PRE-DELIRIC — Early PRE-DELIRIC delirium prediction model

What this tool is and how to interpret its evidence

E-PRE-DELIRIC is the early, admission-time member of the PRE-DELIRIC prediction family. It estimates an adult ICU patient's probability of developing delirium during the ICU stay using nine predictors available at admission. These concern age, prior cognitive impairment, alcohol history, admission category and urgency, mean arterial pressure, corticosteroid use, respiratory failure and blood urea nitrogen. The calculation yields a risk probability, not evidence that delirium is currently present. Its value is the earlier opportunity to plan prevention and repeated assessment compared with the original model, which incorporates information from the first 24 hours.

Wassenaar and colleagues prospectively studied 2,914 patients in 13 ICUs across seven countries. Data from the first two-thirds at each site were used for model development and the remaining third for validation. Delirium incidence was 23.6%. Reported discrimination was moderate, with an area under the curve of 0.76 in development and 0.75 in validation. Later studies have evaluated the model in particular ICU populations, but performance and calibration are not uniform across settings.

E-PRE-DELIRIC should be linked to, rather than counted separately from, the PRE-DELIRIC family. Local data definitions, case mix and clinical practice can alter predicted probabilities. Services should examine calibration before embedding the model in workflow and define what preventive actions follow a risk result. The model neither confirms nor excludes current delirium and must not replace bedside assessment when an acute change is observed.