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Bispectral EEG may detect delirium, predict mortality in older inpatients

Gen Shinozaki

Researchers found that bispectral electroencephalography, or EEG, can predict patient outcomes, including mortality, in older hospitalized patients.

Objective measures to detect delirium are necessary because it is common and dangerous in elderly hospitalized patients and often underdiagnosed, Gen Shinozaki, MD, from the department of psychiatry, University of Iowa Carver College of Medicine, and colleagues wrote in Journal of Clinical Psychiatry.

“We know how to describe delirium, but it’s hard to measure and to pin down the diagnosis. Current assessments rely on subjective checklists that vary between raters and are hard to incorporate into a busy hospital workflow,” Shinozaki told Healio Psychiatry. “We know that delirium results in EEG changes, but traditional EEG is impractical for screening. We hypothesized that a simplified form of EEG can be used for point-of-care delirium screening.”

Shinozaki and colleagues examined whether bispectral EEG (BSEEG) signals were linked to delirium and whether they predict patient outcomes in a prospective cohort study. The researchers analyzed BSEEG scores from 274 inpatients aged 55 years and older admitted to the University of Iowa Hospitals and Clinics to measure their hospital length of stay, discharge disposition and mortality.

The results showed a significant association between delirium and BSEEG score (P < .001). After adjusting for confounders, Shinozaki and colleagues also found that higher BSEEG scores obtained at the beginning of their hospital stay were linked to increased length of stay (P = .001) and discharge not to the patient’ home (P < .01).

After controlling for clinical delirium status along with other confounders, analysis revealed an association between higher BSEEG score at the beginning of their hospital stay and mortality risk (HR = 1.35; 95% CI, 1.04-1.76). In addition, although patients categorized as clinically delirious status with positive BSEEG scores showed the highest mortality, those clinically judged to be delirious with a negative BSEEG score had lower mortality. Furthermore, patients considered nondelirious by clinical assessment who had positive BSEEG scores showed higher mortality, according to the results.

“We think that this simple, quick, bedside screening device can provide objective, high-throughput screening for delirium,” Shinozaki told Healio Psychiatry. “Especially, it can identify people who are at high risk but who would not be detected by current clinical assessments.” – by Savannah Demko

Disclosures: Shinozaki and another author are co-founders of Predelix Medical LLC. and have the patent applications pending. No other authors report relevant financial disclosures.