Bispectral Index Monitoring With Density Spectral Array for Delirium Detection.
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 an 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-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) 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 3D-CAM.


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; 3D-CAM: 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 3D-CAM achieved 50%/78%/0.639 (P = 0.04).


CONCLUSION
Bispectral index monitor + DSA was similar to 3D-CAM 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.
['Luo|Alice|A|', 'Muraida|Susan|S|', 'Pinchotti|Dana|D|', 'Richardson|Elizabeth|E|', 'Ye|Enstin|E|', 'Hollingsworth|Bryce|B|', 'Win|Alexander|A|', 'Myers|Orrin|O|', 'Langsjoen|Jens|J|', 'Valles|Emiliano|E|', 'Zolyomi|Arpad|A|', 'Quinn|Davin K|DK|']
D056805:Consciousness Monitors D003693:Delirium D004569:Electroencephalography D006801:Humans D012680:Sensitivity and Specificity D012984:Software
bispectral index monitoring density spectral array delirium