Brain ProTCT: Deltascan vs DOSS after cardiac surgery

Delirium is a serious and common neuropsychiatric disorder (American Psychiatric Association, 2013) that is related to adverse long-term outcomes (Inouye, Westendorp, & Saczynski, 2014a). Postoperative delirium occurs often in hospitalized older patients following cardiac surgery, with an incidence in the postoperative period of 17% (including elective patients aged ≥45 years, (Koster, Hensens, Schuurmans, & Van Der Palen, 2012) and 13% (including elective adult patients,(ten Broeke, Koster, Konings, Hensens, & van der Palen, 2018)) respectively. Early detection of delirium enables early treatment of the underlying cause. Therefore, screening for delirium in patients at risk is an important part of clinical follow-up after surgery (Inouye, Westendorp, & Saczynski, 2014b; Marcantonio, 2017a; Nederlandse Vereniging voor Klinische Geriatrie, 2013; Samuel et al., 2015)
Although delirium screening is part of routine practice following cardiac surgery, patients with a hypoactive or mixed form of delirium are possibly missed (Marcantonio, 2017b). Current screening methods, such as the DOSS, are subjective. Although the DOSS is a sensitive instrument in research settings, during care-as-usual the sensitivity may decrease to 32% (Numan et al., 2017).
Recently, an objective medical device has been developed that can detect delirium based on a short one-channel EEG measurement: DeltaScan (Numan et al., 2019). Using DeltaScan in routine care may improve the delirium detection (Numan et al., 2019). Furthermore, improved detection of delirium may lead to improved patient outcomes such as length of stay and therefore to reduced hospital costs (Gleason et al., 2015; Lundstrom et al, 2005; Young & George, 2003).

In the present study, we aim to assess whether introduction of DeltaScan in routine clinical care as screening instrument for delirium, will (1) increase the reported incidence of delirium in the postoperative period, and (2) reduce hospital stay of delirious patients in the postoperative period at Thoraxcentrum Twente (TCT).

The use of DeltaScan for delirium screening reduces length of hospital stay and increase the detection of delirium, in comparison with the Delirium Observation Scale

Surgical ward; 30-days after surgery

Patients are screend for delirium with DeltaScan or the Delirium Observation Scale. The treatment of delirium is identical, and is according to hospital protocols.