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Regular Research Article|Articles in Press

Bispectral EEG (BSEEG) algorithm captures high mortality risk among 1077 patients: its relationship to delirium motor subtype

Published:March 07, 2023DOI:https://doi.org/10.1016/j.jagp.2023.03.002

      Highlights

      • What is the primary question addressed by this study? — The question addressed by the study must be limited to only one sentence.
      • →Can the BSEEG method predict patient mortality regardless of age, delirium motor subtype, and device type?
      • What is the main finding of this study? — The finding must be limited to two sentences.
      • →The BSEEG score measured early in the hospitalization was shown to be capable of capturing high mortality risk among patients.
      • What is the meaning of the finding? —The meaning of the finding must be limited to one sentence.
      • →The BSEEG method has a potential to be useful in identifying patients at high risk for poor outcomes with the objective scoring by a simple, easy to use, point-of-care device.

      Abstract

      Objective

      : Delirium is dangerous and a predictor of poor patient outcomes. We have previously reported the utility of the bispectral EEG (BSEEG) with a novel algorithm for the detection of delirium and prediction of patient outcomes including mortality. The present study employed a normalized BSEEG (nBSEEG) score to integrate the previous cohorts to combine their data to investigate the prediction of patient outcomes. We also aimed to test if the BSEEG method can be applicable regardless of age, and independent of delirium motor subtypes.

      Method

      : We calculated nBSEEG score from raw BSEEG data in each cohort and classified patients into BSEEG-positive and BSEEG-negative groups. We used log-rank test and Cox proportional hazards models to predict 90-day and 1-year outcomes for the BSEEG-positive and -negative groups in all subjects and motor subgroups.

      Result

      : A total of 1077 subjects, the BSEEG-positive group showed significantly higher 90-day (hazard ratio 1.33 [95% CI 1.16-1.52] and 1-year (hazard ratio 1.22 [95% CI 1.06-1.40] mortality rates than the negative group after adjustment for covariates such as age, sex, CCI and delirium status. Among patients with different motor subtypes of delirium, the hypoactive group showed significantly higher 90-day (hazard ratio 1.41 [95% CI 1.12-1.76] and 1-year mortality rates (hazard ratio 1.32 [95% CI 1.05-1.67], which remained significant after adjustment for the same covariates.

      Conclusion

      : We found that the BSEEG method is capable of capturing patients at high mortality risk.

      Key Words

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      References

        • Inouye SK.
        Delirium in older persons.
        N Engl J Med. 2006; 354: 1157-1165
        • Fong TG
        • Tulebaev SR
        • Inouye SK.
        Delirium in elderly adults: diagnosis, prevention and treatment.
        Nat Rev Neurol. 2009; 5: 210-220
        • Inouye SK
        • Westendorp RG
        • Saczynski JS.
        Delirium in elderly people.
        Lancet. 2014; 383: 911-922
        • Ely EW
        • Stephens RK
        • Jackson JC
        • Thomason JW
        • Truman B
        • Gordon S
        • et al.
        Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals.
        Crit Care Med. 2004; 32: 106-112
        • Leslie DL
        • Marcantonio ER
        • Zhang Y
        • Leo-Summers L
        • Inouye SK.
        One-year health care costs associated with delirium in the elderly population.
        Arch Intern Med. 2008; 168: 27-32
        • Spronk PE
        • Riekerk B
        • Hofhuis J
        • Rommes JH.
        Occurrence of delirium is severely underestimated in the ICU during daily care.
        Intensive Care Med. 2009; 35: 1276-1280
        • Pisani MA
        • McNicoll L
        • Inouye SK.
        Cognitive impairment in the intensive care unit.
        Clin Chest Med. 2003; 24: 727-737
        • McCusker J
        • Cole M
        • Abrahamowicz M
        • Primeau F
        • Belzile E.
        Delirium predicts 12-month mortality.
        Arch Intern Med. 2002; 162: 457-463
        • Ouimet S
        • Kavanagh BP
        • Gottfried SB
        • Skrobik Y.
        Incidence, risk factors and consequences of ICU delirium.
        Intensive Care Med. 2007; 33: 66-73
        • Kakuma R
        • du Fort GG
        • Arsenault L
        • Perrault A
        • Platt RW
        • Monette J
        • et al.
        Delirium in older emergency department patients discharged home: effect on survival.
        J Am Geriatr Soc. 2003; 51: 443-450
        • Pandharipande PP
        • Girard TD
        • Jackson JC
        • Morandi A
        • Thompson JL
        • Pun BT
        • et al.
        Long-term cognitive impairment after critical illness.
        N Engl J Med. 2013; 369: 1306-1316
        • Fong TG
        • Jones RN
        • Shi P
        • Marcantonio ER
        • Yap L
        • Rudolph JL
        • et al.
        Delirium accelerates cognitive decline in Alzheimer disease.
        Neurology. 2009; 72: 1570-1575
        • Jackson TA
        • Gladman JR
        • Harwood RH
        • MacLullich AM
        • Sampson EL
        • Sheehan B
        • et al.
        Challenges and opportunities in understanding dementia and delirium in the acute hospital.
        PLoS Med. 2017; 14e1002247
        • Inouye SK
        • van Dyck CH
        • Alessi CA
        • Balkin S
        • Siegal AP
        • Horwitz RI.
        Clarifying confusion: the confusion assessment method. A new method for detection of delirium.
        Ann Intern Med. 1990; 113: 941-948
        • Ely EW
        • Inouye SK
        • Bernard GR
        • Gordon S
        • Francis J
        • May L
        • et al.
        Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).
        JAMA. 2001; 286: 2703-2710
        • Ely EW
        • Margolin R
        • Francis J
        • May L
        • Truman B
        • Dittus R
        • et al.
        Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
        Crit Care Med. 2001; 29: 1370-1379
        • Trzepacz PT
        • Mittal D
        • Torres R
        • Kanary K
        • Norton J
        • Jimerson N.
        Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium.
        J Neuropsychiatry Clin Neurosci. 2001; 13: 229-242
        • van Eijk MM
        • van den Boogaard M
        • van Marum RJ
        • Benner P
        • Eikelenboom P
        • Honing ML
        • et al.
        Routine use of the confusion assessment method for the intensive care unit: a multicenter study.
        Am J Respir Crit Care Med. 2011; 184: 340-344
        • Nishimura K
        • Yokoyama K
        • Yamauchi N
        • Koizumi M
        • Harasawa N
        • Yasuda T
        • et al.
        Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan.
        Heart Lung. 2016; 45: 15-20
        • van der Kooi AW
        • Zaal IJ
        • Klijn FA
        • Koek HL
        • Meijer RC
        • Leijten FS
        • et al.
        Delirium detection using EEG: what and how to measure.
        Chest. 2015; 147: 94-101
        • Shinozaki G
        • Chan AC
        • Sparr NA
        • Zarei K
        • Gaul LN
        • Heinzman JT
        • et al.
        Delirium detection by a novel bispectral electroencephalography device in general hospital.
        Psychiatry Clin Neurosci. 2018; 72: 856-863
        • Yamanashi T
        • Crutchley KJ
        • Wahba NE
        • Sullivan EJ
        • Comp KR
        • Kajitani M
        • et al.
        Evaluation of point-of-care thumb-size bispectral electroencephalography device to quantify delirium severity and predict mortality.
        Br J Psychiatry. 2021; : 1-8
        • Kimchi EY
        • Neelagiri A
        • Whitt W
        • Sagi AR
        • Ryan SL
        • Gadbois G
        • et al.
        Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes.
        Neurology. 2019; 93 (e1260-e71)
        • Shinozaki G
        • Bormann NL
        • Chan AC
        • Zarei K
        • Sparr NA
        • Klisares MJ
        • et al.
        Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG.
        J Clin Psychiatry. 2019; 80
        • Saito T
        • Malicoat JR
        • Leyden LR
        • Williams JC
        • Jellison SS
        • Long H
        • et al.
        Mortality prediction by bispectral electroencephalography among 502 patients: its role in dementia.
        Brain Commun. 2021; 3 (fcab037)
        • Wanzek R
        • Bormann N
        • Shabbir Y
        • Saito T
        • Yamada T
        • Shinozaki G.
        Increased mortality in patients with standard EEG findings of 'diffuse slowing'.
        Ann Clin Psychiatry. 2021; 33: 93-100
        • Schuurmans MJ
        • Shortridge-Baggett LM
        • Duursma SA.
        The Delirium Observation Screening Scale: a screening instrument for delirium.
        Res Theory Nurs Pract. 2003; 17: 31-50
        • Nasreddine ZS
        • Phillips NA
        • Bedirian V
        • Charbonneau S
        • Whitehead V
        • Collin I
        • et al.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Kanda Y.
        Investigation of the freely available easy-to-use software 'EZR' for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Charlson M
        • Szatrowski TP
        • Peterson J
        • Gold J.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • Yamanashi T
        • Kajitani M
        • Iwata M
        • Crutchley KJ
        • Marra P
        • Malicoat JR
        • et al.
        Topological data analysis (TDA) enhances bispectral EEG (BSEEG) algorithm for detection of delirium.
        Sci Rep. 2021; 11: 304
        • Inouye SK.
        The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients.
        Am J Med. 1994; 97: 278-288
        • Hayhurst CJ
        • Pandharipande PP
        • Hughes CG.
        Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment.
        Anesthesiology. 2016; 125: 1229-1241
        • Lee JS
        • Tong T
        • Chignell M
        • Tierney MC
        • Goldstein J
        • Eagles D
        • et al.
        Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?.
        Age Ageing. 2022; 51
        • Rai D
        • Garg RK
        • Malhotra HS
        • Verma R
        • Jain A
        • Tiwari SC
        • et al.
        Acute confusional state/delirium: An etiological and prognostic evaluation.
        Ann Indian Acad Neurol. 2014; 17: 30-34
        • Meagher D
        • Moran M
        • Raju B
        • Leonard M
        • Donnelly S
        • Saunders J
        • et al.
        A new data-based motor subtype schema for delirium.
        J Neuropsychiatry Clin Neurosci. 2008; 20: 185-193