Heterogeneity in the definition of delirium in ICUs and association with the intervention effect in randomized controlled trials: a meta-epidemiological study

Lucie Collet; Aymeric Lanore; Camille Alaterre; Jean-Michel Constantin; Guillaume L Martin; Agnès Caille; Arthur James; Agnès Dechartres

doi:10.1186/s13054-023-04411-y

Heterogeneity in the definition of delirium in ICUs and association with the intervention effect in randomized controlled trials: a meta-epidemiological study

Crit Care. 2023 May 4;27(1):170. doi: 10.1186/s13054-023-04411-y.

Authors

Lucie Collet^{1

2}, Aymeric Lanore^#^{1

3}, Camille Alaterre^#², Jean-Michel Constantin², Guillaume L Martin¹, Agnès Caille⁴, Arthur James², Agnès Dechartres⁵

Affiliations

¹ Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpetrière, Département de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
² Sorbonne Université, GRC 29, DMU DREAM, AP-HP, Hôpital Pitié-Salpetrière, Département d'Anesthésie-Réanimation, Paris, France.
³ CIC Neurosciences, Department of Neurology, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.
⁴ Université́ de Tours, Université́ de Nantes, INSERM, SPHERE U1246, Tours, France; INSERM CIC 1415, CHRU de Tours, Tours, France.
⁵ Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpetrière, Département de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. agnes.dechartres@aphp.fr.

^# Contributed equally.

Abstract

Purpose: To evaluate the heterogeneity in the definition of delirium in randomized controlled trials (RCTs) included in meta-analyses of delirium in intensive care units (ICUs) and to explore whether intervention effect depends on the definition used.

Methods: We searched PubMed for meta-analyses including RCTs evaluating prevention or treatment strategies of delirium in ICU. The definition of delirium was collected from RCTs and classified as validated (DSM criteria, CAM-ICU, ICDSC, NEECHAM, DRS-R98) or non-validated (non-validated scales, set of symptoms, physician appreciation or not reported). We conducted a meta-epidemiological analysis to compare intervention effects between trials using or not a validated definition by a two-step method as primary analysis and a multilevel model as secondary analysis. A ratio of odds ratios (ROR) < 1 indicated larger intervention effects in trials using a non-validated definition.

Results: Of 149 RCTs (41 meta-analyses), 109 (73.1%) used a validated definition and 40 (26.8%) did not (including 31 [20.8%] not reporting the definition). The primary analysis of 7 meta-analyses (30 RCTs) found no significant difference in intervention effects between trials using a validated definition and the others (ROR = 0.54, 95% CI 0.27-1.08), whereas the secondary multilevel analysis including 12 meta-analyses (67 RCTs) found significantly larger effects for trials using a non-validated versus a validated definition (ROR = 0.36, 95% CI 0.21-0.62).

Conclusion: The definition of delirium was heterogeneous across RCTs, with one-fifth not reporting how they evaluated delirium. We did not find a significant association with intervention effect in the primary analysis. The secondary analysis including more studies revealed significantly larger intervention effects in trials using a non-validated versus a validated definition.

Keywords: Definition; Delirium; Heterogeneity; Intensive care; Meta-analysis; Meta-epidemiology.

Publication types

Meta-Analysis

MeSH terms

Delirium* / diagnosis
Delirium* / epidemiology
Delirium* / therapy
Epidemiologic Studies
Humans
Intensive Care Units*
Meta-Analysis as Topic
Randomized Controlled Trials as Topic