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dc.contributor.authorBowman, K
dc.contributor.authorJones, L
dc.contributor.authorMasoli, J
dc.contributor.authorMujica-Mota, R
dc.contributor.authorStrain, D
dc.contributor.authorButchart, J
dc.contributor.authorValderas, JM
dc.contributor.authorFortinsky, RH
dc.contributor.authorMelzer, D
dc.contributor.authorDelgado, J
dc.date.accessioned2020-06-18T13:14:38Z
dc.date.issued2020-04-02
dc.description.abstractIMPORTANCE: risk factors for delirium in hospital inpatients are well established, but less is known about whether delirium occurring in the community or during an emergency admission to hospital care might be predicted from routine primary-care records. OBJECTIVES: identify risk factors in primary-care electronic health records (PC-EHR) predictive of delirium occurring in the community or recorded in the initial episode in emergency hospitalisation. Test predictive performance against the cumulative frailty index. DESIGN: Stage 1: case-control; Stages 2 and 3: retrospective cohort. SETTING: clinical practice research datalink: PC-EHR linked to hospital discharge data from England. SUBJECTS: Stage 1: 17,286 patients with delirium aged ≥60 years plus 85,607 controls. Stages 2 and 3: patients ≥ 60 years (n = 429,548 in 2015), split into calibration and validation groups. METHODS: Stage 1: logistic regression to identify associations of 110 candidate risk measures with delirium. Stage 2: calibrating risk factor weights. Stage 3: validation in independent sample using area under the curve (AUC) receiver operating characteristic. RESULTS: fifty-five risk factors were predictive, in domains including: cognitive impairment or mental illness, psychoactive drugs, frailty, infection, hyponatraemia and anticholinergic drugs. The derived model predicted 1-year incident delirium (AUC = 0.867, 0.852:0.881) and mortality (AUC = 0.846, 0.842:0.853), outperforming the frailty index (AUC = 0.761, 0.740:0.782). Individuals with the highest 10% of predicted delirium risk accounted for 55% of incident delirium over 1 year. CONCLUSIONS: a risk factor model for delirium using data in PC-EHR performed well, identifying individuals at risk of new onsets of delirium. This model has potential for supporting preventive interventions.en_GB
dc.description.sponsorshipNational Institute for Health Research (NIHR)en_GB
dc.identifier.citationVol. 49 (3), pp. 374 - 381en_GB
dc.identifier.doi10.1093/ageing/afaa006
dc.identifier.urihttp://hdl.handle.net/10871/121518
dc.language.isoenen_GB
dc.publisherOxford University Press for British Geriatrics Societyen_GB
dc.rights© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comen_GB
dc.subjectdeliriumen_GB
dc.subjectconfusionen_GB
dc.subjectat homeen_GB
dc.subjectmedical recordsen_GB
dc.subjectpredictive modelen_GB
dc.subjectolder peopleen_GB
dc.titlePredicting incident delirium diagnoses using data from primary-care electronic health recordsen_GB
dc.typeArticleen_GB
dc.date.available2020-06-18T13:14:38Z
dc.descriptionThis is the final version. Available on open access from Oxford University Press via the DOI in this recorden_GB
dc.identifier.eissn1468-2834
dc.identifier.journalAge and Ageingen_GB
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/en_GB
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2020-04-02
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2020-06-18T13:12:01Z
refterms.versionFCDVoR
refterms.dateFOA2020-06-18T13:14:42Z
refterms.panelAen_GB
refterms.depositExceptionpublishedGoldOA


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© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Except where otherwise noted, this item's licence is described as © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com