REcognizing DElirium in geriatric Emergency Medicine: The REDEEM risk stratification score

STUDY OBJECTIVE: To derive a risk score that uses variables available early during the ED encounter to identify high-risk geriatric patients who may benefit from delirium screening. METHODS: This was an observational study of older adults age ≥ 75 years who presented to an academic ED and who were screened for delirium during their ED visit. Variable selection from candidate predictors was performed through a LASSO-penalized logistic regression. A risk score was derived from the final prediction model, and predictive accuracy characteristics were calculated with 95% confidence intervals (CIs). RESULTS: From the 967 eligible ED visits, delirium was detected in 107 (11.1%). The area under the curve for the REcognizing DElirium in Emergency Medicine (REDEEM) score was 0.901 (95% CI 0.864 to 0.938). The REEDEM risk score included 10 different variables (7 based on triage information and 3 obtained during early history taking) with a score ranging from −3 to 66. Using an optimal cutoff of ≥ 11, we found a sensitivity of 84.1% (90 of 107 ED delirium patients, 95% CI 75.5% to 90.2%) and a specificity of 86.6% (745 of 860 non-ED delirium patients, 95% CI 84.1% to 88.8%). A lower cutoff of ≥ 5 was found to minimize false negatives with an improved sensitivity at 91.6% (98 of 107 ED delirium patients, 95% CI 84.2% to 95.8%). CONCLUSION: A risk stratification score was derived with the potential to augment delirium recognition in geriatric ED patients. This has the potential to assist on delirium targeted screening of high-risk patients in the ED. Validation of REDEEM, however, is needed prior to implementation.