{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T15:23:24Z","timestamp":1782573804367,"version":"3.54.5"},"reference-count":54,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,24]],"date-time":"2022-09-24T00:00:00Z","timestamp":1663977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union Seventh Framework Programme","award":["602461"],"award-info":[{"award-number":["602461"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Postoperative delirium (POD) is associated with increased complication and mortality rates, particularly among older adult patients. However, guideline recommendations for POD detection and management are poorly implemented. Fast-and-frugal trees (FFTrees), which are simple prediction algorithms, may be useful in this context. We compared the capacity of simple FFTrees with two more complex models\u2014namely, unconstrained classification trees (UDTs) and logistic regression (LogReg)\u2014for the prediction of POD among older surgical patients in the perioperative setting. Models were trained and tested on the European BioCog project clinical dataset. Based on the entire dataset, two different FFTrees were developed for the pre-operative and postoperative settings. Within the pre-operative setting, FFTrees outperformed the more complex UDT algorithm with respect to predictive balanced accuracy, nearing the prediction level of the logistic regression. Within the postoperative setting, FFTrees outperformed both complex models. Applying the best-performing algorithms to the full datasets, we proposed an FFTree using four cues (Charlson Comorbidity Index (CCI), site of surgery, physical status and frailty status) for the pre-operative setting and an FFTree containing only three cues (duration of anesthesia, age and CCI) for the postoperative setting. Given that both FFTrees contained considerably fewer criteria, which can be easily memorized and applied by health professionals in daily routine, FFTrees could help identify patients requiring intensified POD screening.<\/jats:p>","DOI":"10.3390\/jcm11195629","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T01:41:58Z","timestamp":1664156518000},"page":"5629","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Forecasting Postoperative Delirium in Older Adult Patients with Fast-and-Frugal Decision Trees"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4530-7343","authenticated-orcid":false,"given":"Maria","family":"Heinrich","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health@Charit\u00e9 (BIH), Anna-Louisa-Karsch 2, 10178 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-121X","authenticated-orcid":false,"given":"Jan K.","family":"Woike","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK"},{"name":"Max Planck Institute for Human Development, Center for Adaptive Rationality, 14195 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1062-0495","authenticated-orcid":false,"given":"Claudia D.","family":"Spies","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-2673","authenticated-orcid":false,"given":"Odette","family":"Wegwarth","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany"},{"name":"Max Planck Institute for Human Development, Center for Adaptive Rationality, 14195 Berlin, Germany"},{"name":"Heisenberg Chair for Medical Risk Literacy and Evidence-Based Decisions, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hewer, W., Thomas, C., and Drach, L.M. (2016). Delir Beim Alten Menschen, W. Kohlhammer GmbH.","DOI":"10.17433\/978-3-17-023855-8"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1016\/j.lpm.2018.03.012","article-title":"Postoperative delirium","volume":"47","author":"Rengel","year":"2018","journal-title":"Presse Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000140804","article-title":"High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study","volume":"26","author":"Bickel","year":"2008","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.amjsurg.2017.08.034","article-title":"Post-operative delirium is associated with increased 5-year mortality","volume":"214","author":"Moskowitz","year":"2017","journal-title":"Am. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1093\/brain\/aws190","article-title":"Delirium is a strong risk factor for dementia in the oldest-old: A population-based cohort study","volume":"135","author":"Davis","year":"2012","journal-title":"Brain A J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1097\/ALN.0000000000002729","article-title":"Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence","volume":"131","author":"Daiello","year":"2019","journal-title":"Anesthesiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1093\/bja\/aex130","article-title":"Postoperative delirium in elderly patients is associated with subsequent cognitive impairment","volume":"119","author":"Sprung","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_8","first-page":"375","article-title":"Risk factors contributing to postoperative delirium in geriatric patients postorthopedic surgery","volume":"7","author":"Wang","year":"2015","journal-title":"Asia-Pac. Psychiatry Off. J. Pac. Rim Coll. Psychiatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/SLA.0000000000002436","article-title":"Postoperative Delirium as a Target for Surgical Quality Improvement","volume":"268","author":"Berian","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1159\/000017177","article-title":"Predisposing and precipitating factors for delirium in hospitalized older patients","volume":"10","author":"Inouye","year":"1999","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/EJA.0000000000000594","article-title":"European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium","volume":"34","author":"Aldecoa","year":"2017","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/wvn.12536","article-title":"Postoperative Delirium in Older Patients: A Systematic Review of Assessment and Incidence of Postoperative Delirium","volume":"18","author":"Ho","year":"2021","journal-title":"Worldviews Evid. Based Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.jagp.2013.09.005","article-title":"Neuropathogenesis of delirium: Review of current etiologic theories and common pathways","volume":"21","author":"Maldonado","year":"2013","journal-title":"Am. J. Geriatr. Psychiatry Off. J. Am. Assoc. Geriatr. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s00101-016-0218-8","article-title":"Kenntnis und Umsetzung der S3-Leitlinie zum Delirmanagement in Deutschland","volume":"65","author":"Saller","year":"2016","journal-title":"Anaesthesist"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cherak, S.J., Soo, A., Brown, K.N., Ely, E.W., Stelfox, H.T., and Fiest, K.M. (2020). Development and validation of delirium prediction model for critically ill adults parameterized to ICU admission acuity. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0237639"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"110158","DOI":"10.1016\/j.jclinane.2020.110158","article-title":"Development and validation of a delirium risk prediction preoperative model for cardiac surgery patients (DELIPRECAS): An observational multicentre study","volume":"69","author":"Ramasco","year":"2021","journal-title":"J. Clin. Anesth."},{"key":"ref_17","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":"Inouye","year":"1993","journal-title":"Ann. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.mayocp.2020.08.049","article-title":"Predicting Delirium Risk Using an Automated Mayo Delirium Prediction Tool: Development and Validation of a Risk-Stratification Model","volume":"96","author":"Pagali","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_19","first-page":"9959077","article-title":"Development and Validation of a Postoperative Delirium Prediction Model for Elderly Orthopedic Patients in the Intensive Care Unit","volume":"2021","author":"Wang","year":"2021","journal-title":"J. Healthc. Eng."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1007\/s00134-015-3777-2","article-title":"Multinational development and validation of an early prediction model for delirium in ICU patients","volume":"41","author":"Wassenaar","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_21","first-page":"219","article-title":"What alters physicians\u2019 decisions to admit to the coronary care unit?","volume":"45","author":"Green","year":"1997","journal-title":"J. Fam. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1017\/S1930297500006239","article-title":"FFTrees: A toolbox to create, visualize, and evaluate fast-and-frugal decision trees","volume":"12","author":"Phillips","year":"2017","journal-title":"Judgm. Decis. Mak."},{"key":"ref_23","unstructured":"Wegwarth, O. (2007). Deciding the Fast & Frugal Way on the Application of Pharmacodiagnostic Tests in Cancer Care? A Comparative Study of Oncologists\u2019, Pathologists\u2019, and Cancer Patients\u2019 Decision Making in Germany and the USA. [Ph.D. Thesis, Humboldt University]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/j.1365-2753.2010.01426.x","article-title":"Decisions on pharmacogenomic tests in the USA and Germany","volume":"17","author":"Wegwarth","year":"2011","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1037\/dec0000086","article-title":"Integrating and testing natural frequencies, na\u00efve Bayes, and fast-and-frugal trees","volume":"4","author":"Woike","year":"2017","journal-title":"Decision"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1037\/0033-295X.109.3.472","article-title":"Toward a method of selecting among computational models of cognition","volume":"109","author":"Pitt","year":"2002","journal-title":"Psychol. Rev."},{"key":"ref_27","unstructured":"Gigerenzer, G., and Todd, P.M. (1999). The ABC Research Group. Simple Heuristics that Makes Us Smart, Oxford University Press."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1037\/0033-295X.103.4.650","article-title":"Reasoning the fast and frugal way: Models of bounded rationality","volume":"103","author":"Gigerenzer","year":"1996","journal-title":"Psychol. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.jmp.2008.04.003","article-title":"Categorization with limited resources: A family of simple heuristics","volume":"52","author":"Martignon","year":"2008","journal-title":"J. Math. Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1093\/gerona\/glaa182","article-title":"Radiological, Chemical, and Pharmacological Cholinergic System Parameters and Neurocognitive Disorders in Older Presurgical Adults","volume":"76","author":"Heinrich","year":"2021","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association Publishing (2013). American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_33","unstructured":"UNESCO Institute for Statistics (2012). International Standard Classification of Education ISCED 2011, UNESCO Institute for Statistics. Available online: http:\/\/uis.unesco.org\/sites\/default\/files\/documents\/international-standard-classification-of-education-isced-2011-en.pdf."},{"key":"ref_34","first-page":"61","article-title":"Functional evaluation: The barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: Self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1111\/j.1753-4887.1996.tb03793.x","article-title":"Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation","volume":"54","author":"Guigoz","year":"1996","journal-title":"Nutr. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0022-3956(82)90033-4","article-title":"Development and validation of a geriatric depression screening scale: A preliminary report","volume":"17","author":"Yesavage","year":"1982","journal-title":"J. Psychiatr. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption\u2014II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"key":"ref_39","unstructured":"Breiman, L., Friedman, J.H., Olshen, R.A., and Stone, C.J. (1984). Classification and Regression Trees, Routledge. [1st ed.]."},{"key":"ref_40","unstructured":"Therneau, T., and Atkinson, B. (2020, May 02). Recursive Partitioning and Regression Trees. R Package Version 4.1-16. Available online: https:\/\/CRAN.R-project.org\/package=rpart."},{"key":"ref_41","unstructured":"R Core Team (2020). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1037\/a0022684","article-title":"A signal-detection analysis of fast-and-frugal trees","volume":"118","author":"Luan","year":"2011","journal-title":"Psychol. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/EJA.0b013e3283335cee","article-title":"Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium","volume":"27","author":"Radtke","year":"2010","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/SLA.0b013e31818e4776","article-title":"Postoperative delirium in the elderly: Risk factors and outcomes","volume":"249","author":"Robinson","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jama.1994.03510260066030","article-title":"A clinical prediction rule for delirium after elective noncardiac surgery","volume":"271","author":"Marcantonio","year":"1994","journal-title":"Jama"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1136\/bmj.e420","article-title":"Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: Observational multicentre study","volume":"344","author":"Pickkers","year":"2012","journal-title":"BMJ"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1213\/ANE.0000000000004386","article-title":"Development of a Risk Score to Predict Postoperative Delirium in Patients With Hip Fracture","volume":"130","author":"Kim","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1034\/j.1399-6576.2001.045003275.x","article-title":"The assessment of postoperative cognitive function","volume":"45","author":"Rasmussen","year":"2001","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/S0899-9007(98)00171-3","article-title":"The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients","volume":"15","author":"Vellas","year":"1999","journal-title":"Nutrition"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/j.1532-5415.2009.02137.x","article-title":"A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men","volume":"57","author":"Ensrud","year":"2009","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/gerona\/62.7.738","article-title":"A comparison of two approaches to measuring frailty in elderly people","volume":"62","author":"Rockwood","year":"2007","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1093\/oxfordjournals.aje.a009066","article-title":"Exercise intensity and subclinical cardiovascular disease in the elderly. The Cardiovascular Health Study","volume":"145","author":"Siscovick","year":"1997","journal-title":"Am. J. Epidemiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d: A test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/19\/5629\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:38:46Z","timestamp":1760143126000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/19\/5629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,24]]},"references-count":54,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcm11195629"],"URL":"https:\/\/doi.org\/10.3390\/jcm11195629","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,24]]}}}