title: Delirium Screening in Cardiac Surgery (DESCARD): a useful tool for nonpsychiatrists.
abstract: BACKGROUND
  The aim of the study was to set up and validate a predictive scoring system for nonpsychiatrists to facilitate screening of postoperative delirium in cardiac surgery patients.
  
  
  METHODS
  The project was conducted as a cohort study in 5781 subjects. More than 100 pre- and perioperative somatic variables were collected to build up an algorithm. Delirium was diagnosed using Diagnostic and Statistical Manual of Mental Disorders 4th edition. The patient cohort was divided into a training and validation set to perform cross-validation. Scoring systems (Delirium Screening in Cardiac Surgery [DESCARD] tool) were developed for the set of sole preoperative and all perioperative risk factors.
  
  
  RESULTS
  Delirium was found in 236 patients (4.1%). The preoperative model comprised age, weight, total protein concentration, arterial hypertension, mode of surgery (elective/urgent/emergent), preoperative fasting glucose, and form of diabetes treatment (diet/oral agents/insulin). Taking into account all the perioperative variables, the scoring system included postoperative cerebral ischemia and the need for red blood cell transfusion, and arterial hypertension and mode of surgery were excluded. Both pre- and perioperative tools had an excellent overall diagnostic accuracy (area under receiver operator characteristics curve = 0.83 and 0.89, respectively) with higher specificity (92% and 93%, respectively) than sensitivity (60% and 69%, respectively).
  
  
  CONCLUSIONS
  The DESCARD tool might be effective in screening of patients at risk of postoperative delirium and can be easily used by all nonpsychiatrists involved in the care of cardiac surgery patients.
authors.affiliation: First Department of Cardiac Surgery, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland; Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Zabrze, Poland. Electronic address: l.krzych@wp.pl.
authors.forename: Lukasz J
authors.initials: LJ
authors.lastname: Krzych
authors.affiliation: First Department of Cardiology, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland.
authors.forename: Maciej T
authors.initials: MT
authors.lastname: Wybraniec
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland.
authors.forename: Irena
authors.initials: I
authors.lastname: Krupka-Matuszczyk
authors.affiliation: Department of Biostatistics, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Skrzypek
authors.affiliation: First Department of Cardiac Surgery, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland.
authors.forename: Andrzej A
authors.initials: AA
authors.lastname: Bochenek
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D002545:Brain Ischemia / Q000453:epidemiology; D013504:Cardiovascular Surgical Procedures; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D017707:Erythrocyte Transfusion; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011506:Proteins / Q000032:analysis; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D011506:Proteins