The AWOL tool: Derivation and validation of a delirium prediction rule

Vanja C. Douglas, Christine S. Hessler, Gurpreet Dhaliwal, John P. Betjemann, Keiko A. Fukuda, Lama R. Alameddine, Rachael Lucatorto, S. Claiborne Johnston, S. Andrew Josephson

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract

    BACKGROUND: Risk factors for delirium are well-described, yet there is no widely used tool to predict the development of delirium upon admission in hospitalized medical patients. OBJECTIVE: To develop and validate a tool to predict the likelihood of developing delirium during hospitalization. DESIGN: Prospective cohort study with derivation (May 2010-November 2010) and validation (October 2011-March 2012) cohorts. SETTING: Two academic medical centers and 1 Veterans Affairs medical center. PATIENTS: Consecutive medical inpatients (209 in the derivation and 165 in the validation cohort) over age 50 years without delirium at the time of admission. MEASUREMENTS: Delirium assessed daily for up to 6 days using the Confusion Assessment Method. RESULTS: The AWOL prediction rule was derived by assigning 1 point to each of 4 items assessed upon enrollment that were independently associated with the development of delirium (Age≥80 years, failure to spell "World" backward, disOrientation to place, and higher nurse-rated iLlness severity). Higher scores were associated with higher rates of delirium in the derivation and validation cohorts (P for trend<0.001 and 0.025, respectively). Rates of delirium according to score in the combined population were: 0(1/50, 2%), 1(5/141, 4%), 2(15/107, 14%), 3(10/50, 20%), and 4(7/11, 64%) (P for trend<0.001). Area under the receiver operating characteristic curve for the derivation and validation cohorts was 0.81 (0.73-0.90) and 0.69 (0.54-0.83) respectively. CONCLUSIONS: The AWOL prediction rule characterizes medical patients' risk for delirium at the time of hospital admission and could be used for clinical stratification and in trials of delirium prevention.

    Original languageEnglish (US)
    Pages (from-to)493-499
    Number of pages7
    JournalJournal of Hospital Medicine
    Volume8
    Issue number9
    DOIs
    StatePublished - Sep 1 2013

    Fingerprint

    Delirium
    Confusion
    Veterans
    ROC Curve
    Inpatients
    Hospitalization
    Cohort Studies
    Nurses
    Prospective Studies

    ASJC Scopus subject areas

    • Health Policy
    • Assessment and Diagnosis
    • Care Planning
    • Fundamentals and skills
    • Leadership and Management

    Cite this

    Douglas, V. C., Hessler, C. S., Dhaliwal, G., Betjemann, J. P., Fukuda, K. A., Alameddine, L. R., ... Josephson, S. A. (2013). The AWOL tool: Derivation and validation of a delirium prediction rule. Journal of Hospital Medicine, 8(9), 493-499. https://doi.org/10.1002/jhm.2062

    The AWOL tool : Derivation and validation of a delirium prediction rule. / Douglas, Vanja C.; Hessler, Christine S.; Dhaliwal, Gurpreet; Betjemann, John P.; Fukuda, Keiko A.; Alameddine, Lama R.; Lucatorto, Rachael; Johnston, S. Claiborne; Josephson, S. Andrew.

    In: Journal of Hospital Medicine, Vol. 8, No. 9, 01.09.2013, p. 493-499.

    Research output: Contribution to journalArticle

    Douglas, VC, Hessler, CS, Dhaliwal, G, Betjemann, JP, Fukuda, KA, Alameddine, LR, Lucatorto, R, Johnston, SC & Josephson, SA 2013, 'The AWOL tool: Derivation and validation of a delirium prediction rule', Journal of Hospital Medicine, vol. 8, no. 9, pp. 493-499. https://doi.org/10.1002/jhm.2062
    Douglas VC, Hessler CS, Dhaliwal G, Betjemann JP, Fukuda KA, Alameddine LR et al. The AWOL tool: Derivation and validation of a delirium prediction rule. Journal of Hospital Medicine. 2013 Sep 1;8(9):493-499. https://doi.org/10.1002/jhm.2062
    Douglas, Vanja C. ; Hessler, Christine S. ; Dhaliwal, Gurpreet ; Betjemann, John P. ; Fukuda, Keiko A. ; Alameddine, Lama R. ; Lucatorto, Rachael ; Johnston, S. Claiborne ; Josephson, S. Andrew. / The AWOL tool : Derivation and validation of a delirium prediction rule. In: Journal of Hospital Medicine. 2013 ; Vol. 8, No. 9. pp. 493-499.
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    abstract = "BACKGROUND: Risk factors for delirium are well-described, yet there is no widely used tool to predict the development of delirium upon admission in hospitalized medical patients. OBJECTIVE: To develop and validate a tool to predict the likelihood of developing delirium during hospitalization. DESIGN: Prospective cohort study with derivation (May 2010-November 2010) and validation (October 2011-March 2012) cohorts. SETTING: Two academic medical centers and 1 Veterans Affairs medical center. PATIENTS: Consecutive medical inpatients (209 in the derivation and 165 in the validation cohort) over age 50 years without delirium at the time of admission. MEASUREMENTS: Delirium assessed daily for up to 6 days using the Confusion Assessment Method. RESULTS: The AWOL prediction rule was derived by assigning 1 point to each of 4 items assessed upon enrollment that were independently associated with the development of delirium (Age≥80 years, failure to spell {"}World{"} backward, disOrientation to place, and higher nurse-rated iLlness severity). Higher scores were associated with higher rates of delirium in the derivation and validation cohorts (P for trend<0.001 and 0.025, respectively). Rates of delirium according to score in the combined population were: 0(1/50, 2{\%}), 1(5/141, 4{\%}), 2(15/107, 14{\%}), 3(10/50, 20{\%}), and 4(7/11, 64{\%}) (P for trend<0.001). Area under the receiver operating characteristic curve for the derivation and validation cohorts was 0.81 (0.73-0.90) and 0.69 (0.54-0.83) respectively. CONCLUSIONS: The AWOL prediction rule characterizes medical patients' risk for delirium at the time of hospital admission and could be used for clinical stratification and in trials of delirium prevention.",
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    AU - Douglas, Vanja C.

    AU - Hessler, Christine S.

    AU - Dhaliwal, Gurpreet

    AU - Betjemann, John P.

    AU - Fukuda, Keiko A.

    AU - Alameddine, Lama R.

    AU - Lucatorto, Rachael

    AU - Johnston, S. Claiborne

    AU - Josephson, S. Andrew

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    N2 - BACKGROUND: Risk factors for delirium are well-described, yet there is no widely used tool to predict the development of delirium upon admission in hospitalized medical patients. OBJECTIVE: To develop and validate a tool to predict the likelihood of developing delirium during hospitalization. DESIGN: Prospective cohort study with derivation (May 2010-November 2010) and validation (October 2011-March 2012) cohorts. SETTING: Two academic medical centers and 1 Veterans Affairs medical center. PATIENTS: Consecutive medical inpatients (209 in the derivation and 165 in the validation cohort) over age 50 years without delirium at the time of admission. MEASUREMENTS: Delirium assessed daily for up to 6 days using the Confusion Assessment Method. RESULTS: The AWOL prediction rule was derived by assigning 1 point to each of 4 items assessed upon enrollment that were independently associated with the development of delirium (Age≥80 years, failure to spell "World" backward, disOrientation to place, and higher nurse-rated iLlness severity). Higher scores were associated with higher rates of delirium in the derivation and validation cohorts (P for trend<0.001 and 0.025, respectively). Rates of delirium according to score in the combined population were: 0(1/50, 2%), 1(5/141, 4%), 2(15/107, 14%), 3(10/50, 20%), and 4(7/11, 64%) (P for trend<0.001). Area under the receiver operating characteristic curve for the derivation and validation cohorts was 0.81 (0.73-0.90) and 0.69 (0.54-0.83) respectively. CONCLUSIONS: The AWOL prediction rule characterizes medical patients' risk for delirium at the time of hospital admission and could be used for clinical stratification and in trials of delirium prevention.

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