{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:08:18Z","timestamp":1740146898785,"version":"3.37.3"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R33 AG062884"],"award-info":[{"award-number":["R33 AG062884"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R33 AG062884"],"award-info":[{"award-number":["R33 AG062884"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>The purpose of this systematic review was to assess risk of bias in existing prognostic models of hospital-induced delirium for medical-surgical units.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>APA PsycInfo, CINAHL, MEDLINE, and Web of Science Core Collection were searched on July 8, 2022, to identify original studies which developed and validated prognostic models of hospital-induced delirium for adult patients who were hospitalized in medical-surgical units. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies was used for data extraction. The Prediction Model Risk of Bias Assessment Tool was used to assess risk of bias. Risk of bias was assessed across four domains: participants, predictors, outcome, and analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Thirteen studies were included in the qualitative synthesis, including ten model development and validation studies and three model validation only studies. The methods in all of the studies were rated to be at high overall risk of bias. The methods of statistical analysis were the greatest source of bias. External validity of models in the included studies was tested at low levels of transportability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our findings highlight the ongoing scientific challenge of developing a valid prognostic model of hospital-induced delirium for medical-surgical units to tailor preventive interventions to patients who are at high risk of this iatrogenic condition. With limited knowledge about generalizable prognosis of hospital-induced delirium in medical-surgical units, existing prognostic models should be used with caution when creating clinical practice policies. Future research protocols must include robust study designs which take into account the perspectives of clinicians to identify and validate risk factors of hospital-induced delirium for accurate and generalizable prognosis in medical-surgical units.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0285527","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T17:33:08Z","timestamp":1692293588000},"page":"e0285527","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk of bias in prognostic models of hospital-induced delirium for medical-surgical units: A systematic review"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9806-8553","authenticated-orcid":true,"given":"Urszula A.","family":"Snigurska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiyang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah E.","family":"Ser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamara G. R.","family":"Macieira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1653-3816","authenticated-orcid":true,"given":"Margaret","family":"Ansell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lindberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Prosperi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ragnhildur I.","family":"Bjarnadottir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Lucero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"issue":"1","key":"pone.0285527.ref001","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1001\/archinternmed.2007.4","article-title":"One-year health care costs associated with delirium in the elderly population","volume":"168","author":"DL Leslie","year":"2008","journal-title":"Arch Intern Med"},{"key":"pone.0285527.ref002","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental DisordersAccessed December","author":"American Psychiatric Association","year":"2013","edition":"5"},{"issue":"3","key":"pone.0285527.ref003","first-page":"150","article-title":"Delirium in the elderly: A review.","volume":"23","author":"S Wass","year":"2008","journal-title":"Oman Med J."},{"issue":"3","key":"pone.0285527.ref004","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1093\/ageing\/afaa040","article-title":"The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: A systematic review and meta-analysis study.","volume":"49","author":"K Gibb","year":"2020","journal-title":"Age Ageing"},{"issue":"9920","key":"pone.0285527.ref005","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"SK Inouye","year":"2014","journal-title":"Lancet"},{"issue":"1","key":"pone.0285527.ref006","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/s12877-020-01723-4","article-title":"A call to action for delirium research: Meta-analysis and regression of delirium associated mortality.","volume":"20","author":"MZ Aung Thein","year":"2020","journal-title":"BMC Geriatr."},{"issue":"9","key":"pone.0285527.ref007","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1056\/NEJM199903043400901","article-title":"A multicomponent intervention to prevent delirium in hospitalized older patients","volume":"340","author":"SK Inouye","year":"1999","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0285527.ref008","doi-asserted-by":"crossref","first-page":"474","DOI":"10.7326\/0003-4819-119-6-199309150-00005","article-title":"A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics","volume":"119","author":"SK Inouye","year":"1993","journal-title":"Ann Intern Med"},{"issue":"10","key":"pone.0285527.ref009","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.jagp.2018.06.007","article-title":"Hospital Elder Life Program: Systematic review and meta-analysis of effectiveness.","volume":"26","author":"TT Hshieh","year":"2018","journal-title":"Am J Geriatr Psychiatry."},{"key":"pone.0285527.ref010","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ejim.2017.09.012","article-title":"The clinical usefulness of prognostic prediction models in critical illness","volume":"45","author":"T Baker","year":"2017","journal-title":"Eur J Intern Med"},{"key":"pone.0285527.ref011","doi-asserted-by":"crossref","first-page":"102880","DOI":"10.1016\/j.iccn.2020.102880","article-title":"Delirium risk prediction models for intensive care unit patients: A systematic review.","volume":"60","author":"J Chen","year":"2020","journal-title":"Intensive Crit Care Nurs"},{"issue":"2","key":"pone.0285527.ref012","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.21037\/apm-20-1183","article-title":"Risk predictive models for delirium in the intensive care unit: A systematic review and meta-analysis.","volume":"10","author":"X Chen","year":"2021","journal-title":"Ann Palliat Med"},{"issue":"3","key":"pone.0285527.ref013","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/bja\/aew476","article-title":"Risk prediction models for delirium in the intensive care unit after cardiac surgery: A systematic review and independent external validation","volume":"118","author":"A Lee","year":"2017","journal-title":"Br J Anaesth"},{"issue":"4","key":"pone.0285527.ref014","doi-asserted-by":"crossref","first-page":"e019223","DOI":"10.1136\/bmjopen-2017-019223","article-title":"Systematic review of prediction models for delirium in the older adult inpatient","volume":"8","author":"H Lindroth","year":"2018","journal-title":"BMJ Open"},{"issue":"12","key":"pone.0285527.ref015","doi-asserted-by":"crossref","first-page":"e0296","DOI":"10.1097\/CCE.0000000000000296","article-title":"ICU delirium-prediction models: A systematic review.","volume":"2","author":"MM Ruppert","year":"2020","journal-title":"Crit Care Explor"},{"issue":"12","key":"pone.0285527.ref016","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1111\/jgs.13138","article-title":"Risk prediction models for postoperative delirium: A systematic review and meta-analysis.","volume":"62","author":"LC van Meenen","year":"2014","journal-title":"J Am Geriatr Soc"},{"issue":"12","key":"pone.0285527.ref017","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.amjmed.2019.05.035","article-title":"Initiative for prevention and early identification of delirium in medical-surgical units: Lessons learned in the past five years","volume":"132","author":"N Rohatgi","year":"2019","journal-title":"Am J Med"},{"key":"pone.0285527.ref018","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"issue":"12","key":"pone.0285527.ref019","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: The confusion assessment method. A new method for detection of delirium","volume":"113","author":"SK Inouye","year":"1990","journal-title":"Ann Intern Med"},{"issue":"21","key":"pone.0285527.ref020","doi-asserted-by":"crossref","first-page":"2703","DOI":"10.1001\/jama.286.21.2703","article-title":"Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).","volume":"286","author":"EW Ely","year":"2001","journal-title":"JAMA"},{"issue":"10","key":"pone.0285527.ref021","doi-asserted-by":"crossref","first-page":"e1001744","DOI":"10.1371\/journal.pmed.1001744","article-title":"Critical appraisal and data extraction for systematic reviews of prediction modelling studies: The CHARMS checklist.","volume":"11","author":"KG Moons","year":"2014","journal-title":"PLoS Med."},{"issue":"1","key":"pone.0285527.ref022","doi-asserted-by":"crossref","first-page":"W1","DOI":"10.7326\/M18-1377","article-title":"PROBAST: A tool to assess risk of bias and applicability of prediction model studies: Explanation and elaboration","volume":"170","author":"KGM Moons","year":"2019","journal-title":"Ann Intern Med"},{"issue":"8","key":"pone.0285527.ref023","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/j.1532-5415.1994.tb06551.x","article-title":"Delirium in hospitalized older persons: Outcomes and predictors.","volume":"42","author":"P Pompei","year":"1994","journal-title":"J Am Geriatr Soc"},{"issue":"11","key":"pone.0285527.ref024","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1001\/jama.1996.03530350034031","article-title":"Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability","volume":"275","author":"SK Inouye","year":"1996","journal-title":"JAMA"},{"issue":"4","key":"pone.0285527.ref025","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/ageing\/25.4.317","article-title":"Predicting delirium in elderly patients: Development and validation of a risk-stratification model","volume":"25","author":"ST O\u2019Keeffe","year":"1996","journal-title":"Age Ageing"},{"issue":"5","key":"pone.0285527.ref026","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/j.1532-5415.2006.00704.x","article-title":"Risk factors and prediction of postoperative delirium in elderly hip-surgery patients: Implementation and validation of a medical risk factor model.","volume":"54","author":"KJ Kalisvaart","year":"2006","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"pone.0285527.ref027","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/01.anes.0000278905.07899.df","article-title":"Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery","volume":"107","author":"JM Leung","year":"2007","journal-title":"Anesthesiology"},{"issue":"10","key":"pone.0285527.ref028","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.jagp.2012.08.009","article-title":"A prediction rule for the development of delirium among patients in medical wards: Chi-Square Automatic Interaction Detector (CHAID) decision tree analysis model.","volume":"21","author":"D Kobayashi","year":"2013","journal-title":"Am J Geriatr Psychiatry."},{"issue":"3","key":"pone.0285527.ref029","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1093\/ageing\/aft141","article-title":"Development and validation of a delirium predictive score in older people","volume":"43","author":"MP Carrasco","year":"2014","journal-title":"Age Ageing"},{"issue":"6","key":"pone.0285527.ref030","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/0891988716666380","article-title":"Preoperative cognitive performance dominates risk for delirium among older adults.","volume":"29","author":"RN Jones","year":"2016","journal-title":"J Geriatr Psychiatry Neurol"},{"issue":"8","key":"pone.0285527.ref031","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1002\/cam4.1106","article-title":"Identification of patients with cancer with a high risk to develop delirium","volume":"6","author":"ECW Neefjes","year":"2017","journal-title":"Cancer Med"},{"issue":"9","key":"pone.0285527.ref032","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1093\/jamia\/ocaa113","article-title":"Risk prediction of delirium in hospitalized patients using machine learning: An implementation and prospective evaluation study.","volume":"27","author":"S Jauk","year":"2020","journal-title":"J Am Med Inform Assoc.Jul 1"},{"issue":"1","key":"pone.0285527.ref033","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s41999-021-00562-9","article-title":"Developing a machine learning model to identify delirium risk in geriatric internal medicine inpatients","volume":"13","author":"Q Li","year":"2022","journal-title":"Eur Geriatr Med"},{"issue":"4","key":"pone.0285527.ref034","doi-asserted-by":"crossref","first-page":"e054023","DOI":"10.1136\/bmjopen-2021-054023","article-title":"Head-to-head comparison of 14 prediction models for postoperative delirium in elderly non-ICU patients: An external validation study","volume":"12","author":"CK Wong","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0285527.ref035","first-page":"32","article-title":"Development and validation of a multivariable prediction model for the occurrence of delirium in hospitalized gerontopsychiatry and internal medicine patients","volume":"236","author":"D Kramer","year":"2017","journal-title":"Stud Health Technol Inform"},{"issue":"1","key":"pone.0285527.ref036","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1159\/000022130","article-title":"Risk factors and incidence of postoperative delirium in elderly Chinese patients","volume":"46","author":"YT Dai","year":"2000","journal-title":"Gerontology"},{"issue":"4","key":"pone.0285527.ref037","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s11096-016-0312-7","article-title":"The development of an automated ward independent delirium risk prediction model","volume":"38","author":"HA de Wit","year":"2016","journal-title":"Int J Clin Pharm"},{"key":"pone.0285527.ref038","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.genhosppsych.2018.09.004","article-title":"Validity of a screening method for delirium risk in older patients admitted to a general hospital in the Netherlands.","volume":"55","author":"R Ettema","year":"2018","journal-title":"Gen Hosp Psychiatry"},{"issue":"2","key":"pone.0285527.ref039","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1093\/ageing\/afh245","article-title":"Predicting post-operative delirium in elective orthopaedic patients: The Delirium Elderly At-Risk (DEAR) instrument.","volume":"34","author":"SH Freter","year":"2005","journal-title":"Age Ageing."},{"issue":"4","key":"pone.0285527.ref040","doi-asserted-by":"crossref","first-page":"e181405","DOI":"10.1001\/jamanetworkopen.2018.1405","article-title":"Performance of electronic prediction rules for prevalent delirium at hospital admission","volume":"1","author":"CW Halladay","year":"2018","journal-title":"JAMA Netw Open"},{"issue":"12","key":"pone.0285527.ref041","doi-asserted-by":"crossref","first-page":"e3072","DOI":"10.1097\/MD.0000000000003072","article-title":"Delirium Prediction based on Hospital Information (Delphi) in general surgery patients.","volume":"95","author":"MY Kim","year":"2016","journal-title":"Medicine (Baltimore)."},{"issue":"2","key":"pone.0285527.ref042","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/S0163-8343(01)00117-7","article-title":"Preoperative risk factors for postoperative delirium.","volume":"23","author":"D Litaker","year":"2001","journal-title":"Gen Hosp Psychiatry."},{"issue":"2","key":"pone.0285527.ref043","first-page":"226","article-title":"Delirium risk stratification in consecutive unselected admissions to acute medicine: Validation of a susceptibility score based on factors identified externally in pooled data for use at entry to the acute care pathway.","volume":"46","author":"ST Pendlebury","year":"2017","journal-title":"Age Ageing."},{"issue":"2","key":"pone.0285527.ref044","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1161\/CIRCULATIONAHA.108.795260","article-title":"Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery","volume":"119","author":"JL Rudolph","year":"2009","journal-title":"Circulation"},{"issue":"3","key":"pone.0285527.ref045","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jamda.2015.10.020","article-title":"Validation of a delirium risk assessment using electronic medical record information.","volume":"17","author":"JL Rudolph","year":"2016","journal-title":"J Am Med Dir Assoc"},{"issue":"3","key":"pone.0285527.ref046","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1177\/1474515117733365","article-title":"Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist","volume":"17","author":"M ten Broeke","year":"2018","journal-title":"Eur J Cardiovasc Nurs."},{"issue":"2","key":"pone.0285527.ref047","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.injury.2018.10.034","article-title":"Predictive nomogram for postoperative delirium in elderly patients with a hip fracture.","volume":"50","author":"X Zhang","year":"2019","journal-title":"Injury."},{"issue":"2","key":"pone.0285527.ref048","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1177\/0962280214558972","article-title":"Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models.","volume":"26","author":"PC Austin","year":"2017","journal-title":"Stat Methods Med Res"},{"key":"pone.0285527.ref049","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-16399-0","volume-title":"Clinical Prediction Models A Practical Approach to Development, Validation, and Updating","author":"EW Steyerberg","year":"2019","edition":"2"},{"issue":"8","key":"pone.0285527.ref050","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0895-4356(01)00341-9","article-title":"Internal validation of predictive models: Efficiency of some procedures for logistic regression analysis.","volume":"54","author":"EW Steyerberg","year":"2001","journal-title":"J Clin Epidemiol."},{"issue":"6","key":"pone.0285527.ref051","doi-asserted-by":"crossref","first-page":"515","DOI":"10.7326\/0003-4819-130-6-199903160-00016","article-title":"Assessing the generalizability of prognostic information","volume":"130","author":"AC Justice","year":"1999","journal-title":"Ann Intern Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0285527","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T17:33:38Z","timestamp":1692293618000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0285527"}},"subtitle":[],"editor":[{"given":"Blessing Onyinye","family":"Ukoha-kalu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,8,17]]},"references-count":51,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0285527","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2023,8,17]]}}}