Bispectral Index Monitoring With Density Spectral Array for Delirium Detection

Document Type

Article

Publication Title

Psychosomatics

Publication Date

1-1-2020

Abstract

Background: Delirium in hospitalized patients often goes undetected. Cerebral state monitors, which measure limited-channel electroencephalography, have shown potential for improving delirium detection. Objective: The aim of this study was to compare a FDA-approved cerebral state monitor, bispectral index monitoring with density spectral array (DSA), for delirium identification with clinical screening methods. Methods: Hospitalized patients receiving psychiatric consultation were assessed for delirium using the 3-dimensional–Confusion Assessment Method and underwent bispectral index monitor + DSA monitoring. Visual inspection of frequency band power of the DSA was performed by 2 trained independent raters. Average hue values were calculated for each frequency band using image analysis software as the device did not allow for extraction of raw electroencephalography data. Delirious versus nondelirious group averages, sensitivity, specificity, and area under the curve were calculated for significant DSA variables and the 3-dimensional–Confusion Assessment Method. Results: In an initial cohort of 43 patients, visual ratings of the DSA were not associated with delirium (P > 0.1). In a larger cohort of 123 subjects, multiple band hue ratios were associated with delirium, although none survived correction for multiple comparisons. In a subgroup of 74 non-neurological patients, low theta/low delta ratio was significantly associated with delirium (P = 0.001) (sensitivity/specificity/area under the curve: 83%/70%/0.757; 3-dimensional–Confusion Assessment Method: 67%/77%/0.717; paired-sample area under the curve difference: -0.040, P = 0.68). In 21 patients with dementia, low theta power demonstrated significantly greater sensitivity/specificity/area under the curve of 83%/78%/0.824, whereas 3-dimensional–Confusion Assessment Method achieved 50%/78%/0.639 (P = 0.04). Conclusion: Bispectral index monitor + DSA was similar to 3-dimensional–Confusion Assessment Method for detecting delirium in hospitalized patients with and without neurological disorders, and was significantly more accurate in patients with dementia. More studies are needed to validate the use of cerebral state monitors for quantitative delirium detection.

Volume

62

Issue

3

DOI

10.1016/j.psym.2020.08.008

ISSN

00333182

E-ISSN

15457206

Funding Sponsor

U.S. Department of Defense

Funding Number

W81XWH-17-1-0432

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