Critical Care Explorations (Jan 2022)

VE-CAM-S: Visual EEG-Based Grading of Delirium Severity and Associations With Clinical Outcomes

  • Ryan A. Tesh, BSc,
  • Haoqi Sun, PhD,
  • Jin Jing, PhD,
  • Mike Westmeijer, MSc,
  • Anudeepthi Neelagiri, MD,
  • Subapriya Rajan, MD,
  • Parimala V. Krishnamurthy, MD,
  • Pooja Sikka, BA,
  • Syed A. Quadri, MD,
  • Michael J. Leone, MSc,
  • Luis Paixao, MD, MSc,
  • Ezhil Panneerselvam, MD,
  • Christine Eckhardt, MD, MSc,
  • Aaron F. Struck, MD,
  • Peter W. Kaplan, MD,
  • Oluwaseun Akeju, MD,
  • Daniel Jones,
  • Eyal Y. Kimchi, MD, PhD,
  • M. Brandon Westover, MD, PhD

DOI
https://doi.org/10.1097/CCE.0000000000000611
Journal volume & issue
Vol. 4, no. 1
p. e0611

Abstract

Read online

OBJECTIVES:. To develop a physiologic grading system for the severity of acute encephalopathy manifesting as delirium or coma, based on EEG, and to investigate its association with clinical outcomes. DESIGN:. This prospective, single-center, observational cohort study was conducted from August 2015 to December 2016 and October 2018 to December 2019. SETTING:. Academic medical center, all inpatient wards. PATIENTS/SUBJECTS:. Adult inpatients undergoing a clinical EEG recording; excluded if deaf, severely aphasic, developmentally delayed, non-English speaking (if noncomatose), or if goals of care focused primarily on comfort measures. Four-hundred six subjects were assessed; two were excluded due to technical EEG difficulties. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. A machine learning model, with visually coded EEG features as inputs, was developed to produce scores that correlate with behavioral assessments of delirium severity (Confusion Assessment Method-Severity [CAM-S] Long Form [LF] scores) or coma; evaluated using Spearman R correlation; area under the receiver operating characteristic curve (AUC); and calibration curves. Associations of Visual EEG Confusion Assessment Method Severity (VE-CAM-S) were measured for three outcomes: functional status at discharge (via Glasgow Outcome Score [GOS]), inhospital mortality, and 3-month mortality. Four-hundred four subjects were analyzed (mean [sd] age, 59.8 yr [17.6 yr]; 232 [57%] male; 320 [79%] White; 339 [84%] non-Hispanic); 132 (33%) without delirium or coma, 143 (35%) with delirium, and 129 (32%) with coma. VE-CAM-S scores correlated strongly with CAM-S scores (Spearman correlation 0.67 [0.62–0.73]; p < 0.001) and showed excellent discrimination between levels of delirium (CAM-S LF = 0 vs ≥ 4, AUC 0.85 [0.78–0.92], calibration slope of 1.04 [0.87–1.19] for CAM-S LF ≤ 4 vs ≥ 5). VE-CAM-S scores were strongly associated with important clinical outcomes including inhospital mortality (AUC 0.79 [0.72–0.84]), 3-month mortality (AUC 0.78 [0.71–0.83]), and GOS at discharge (0.76 [0.69–0.82]). CONCLUSIONS:. VE-CAM-S is a physiologic grading scale for the severity of symptoms in the setting of delirium and coma, based on visually assessed electroencephalography features. VE-CAM-S scores are strongly associated with clinical outcomes.