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A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics
Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME.. Annals of internal medicine, 1993-09-01
Topic: Risk, prevention and care in population studies
Objective To prospectively develop and validate a predictive model for the occurrence of new delirium in hospitalized elderly medical patients based on characteristics present at admission. Design Two prospective cohort studies done in tandem. Setting University teaching hospital. Patients The development cohort included 107 hospitalized general medical patients 70 years or older who did not have dementia or delirium at admission. The validation cohort included 174 comparable patients. Measurements Patients were assessed daily for delirium using a standardized, validated instrument. The predictive model developed in the initial cohort was then validated in a separate cohort of patients. Results Delirium developed in 27 of 107 patients (25%) in the development cohort. Four independent baseline risk factors for delirium were identified using proportional hazards analysis: These included vision impairment (adjusted relative risk, 3.5; 95% Cl, 1.2 to 10.7); severe illness (relative risk, 3.5; Cl, 1.5 to 8.2); cognitive impairment (relative risk, 2.8; Cl, 1.2 to 6.7); and a high blood urea nitrogen/creatinine ratio (relative risk, 2.0; Cl, 0.9 to 4.6). A risk stratification system was developed by assigning 1 point for each risk factor present. Rates of delirium for low- (0 points), intermediate- (1 to 2 points), and high-risk (3 to 4 points) groups were 9%, 23%, and 83% (P Conclusions Delirium among elderly hospitalized patients is common, and a simple predictive model based on four risk factors can be used at admission to identify elderly persons at the greatest risk.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Inouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D., & Tinetti, M. E. (1993). A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Annals of internal medicine. https://doi.org/10.7326/0003-4819-119-6-199309150-00005
Vancouver
Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Annals of internal medicine. 1993. doi:10.7326/0003-4819-119-6-199309150-00005. PMID: 8357112.
BibTeX
@article{inouye1993-8357112,
author = {Inouye, S. K. and Viscoli, C. M. and Horwitz, R. I. and Hurst, L. D. and Tinetti, M. E.},
title = {{A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics}},
journal = {Annals of internal medicine},
year = {1993},
doi = {10.7326/0003-4819-119-6-199309150-00005},
pmid = {8357112},
url = {https://doi.org/10.7326/0003-4819-119-6-199309150-00005}
}
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Key findings
- Results Delirium developed in 27 of 107 patients (25%) in the development cohort.
Why it matters
This study developed a model based on admission characteristics to predict which hospitalized elderly patients would develop delirium. It is a prediction tool, not a treatment or prevention for Alzheimer's disease.
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Study details
- Study designcohort study
- Participants107
- Evidence strengthModerate
How this study scored 65/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 62 of the 96 points we could judge it on, which is 65 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Annals of internal medicine) |
| Journal's citation record | 4 / 4 | Annals of Internal Medicine: journal h-index 648 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1993 — older than 20 years, still counted |
| Sample size | 2 / 4 | 107 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 865 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 24.7 citations a year over 35 year(s) since 1993 |
| Impact for its field and year | 4 / 6 | Cited 9.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 17 other studies in this library |
| Still being cited | 2 / 4 | Cited 47 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 2 / 3 | Yale University: institution h-index 1,927 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 8357112) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 62 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 62 of the 96 points we could judge it on is 65 out of 100. |
| Total | 65 / 100 | — |
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