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Development and Validation of a Routine Electronic Health Record-Based Delirium Prediction Model for Surgical Patients Without Dementia: Retrospective Case-Control Study
Emma Holler, Christina Ludema, Zina Ben Miled, Molly S. Rosenberg, Corey Andrew Kalbaugh, Malaz A. Boustani, Sanjay K. Mohanty. JMIR Perioperative Medicine, 2025-01-09
Topic: Risk, prevention and care in population studies
The study cohort included 7167 delirium cases and 7167 matched controls. XGB outperformed all other classifiers. AUROCs were highest for XGB models trained on 12 months of preadmission data. The best-performing XGB model achieved a mean AUROC of 0.79 (SD 0.01) on the holdout set, which decreased to 0.69-0.74 (SD 0.02) when externally validated on data from other hospitals. Our routine EHR-based POD prediction models demonstrated good predictive ability using a limited set of preadmission and surgical variables, though their generalizability was limited. The proposed models could be used as a scalable, automated screening tool to identify patients at high risk of POD at the time of hospital admission.
Key findings
- The study cohort included 7167 delirium cases and 7167 matched controls.
- AUROCs were highest for XGB models trained on 12 months of preadmission data.
- The best-performing XGB model achieved a mean AUROC of 0.79 (SD 0.01) on the holdout set, which decreased to 0.69-0.74 (SD 0.02) when externally validated on data from other hospitals.
- Our routine EHR-based POD prediction models demonstrated good predictive ability using a limited set of preadmission and surgical variables, though their generalizability was limited.
- The proposed models could be used as a scalable, automated screening tool to identify patients at high risk of POD at the time of hospital admission.
Why it matters
This study developed electronic health record-based models to predict postoperative delirium in surgical patients without dementia, with the best model achieving good predictive ability on internal data. However, performance decreased when validated on data from other hospitals, indicating limited generalisability.
Study details
- Participants7,167
- Evidence strengthModerate
How this study scored 40/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JMIR Perioperative Medicine) |
| Journal's citation record | 0 / 4 | JMIR Perioperative Medicine: journal h-index 20 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| 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 | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 7,167 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 | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 1 / 6 | Cited 0.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Sanjay Mohanty: h-index 14 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Indiana University: institution h-index 926 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39786865) |
| Free to read | 2 / 2 | Free to read |
| Total | 40 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Holler, E., Ludema, C., Miled, Z. B., Rosenberg, M. S., Kalbaugh, C. A., Boustani, M. A., et al. (2025). Development and Validation of a Routine Electronic Health Record-Based Delirium Prediction Model for Surgical Patients Without Dementia: Retrospective Case-Control Study. JMIR Perioperative Medicine. https://doi.org/10.2196/59422
Vancouver
Holler E, Ludema C, Miled ZB, Rosenberg MS, Kalbaugh CA, Boustani MA, et al. Development and Validation of a Routine Electronic Health Record-Based Delirium Prediction Model for Surgical Patients Without Dementia: Retrospective Case-Control Study. JMIR Perioperative Medicine. 2025. doi:10.2196/59422. PMID: 39786865.
BibTeX
@article{holler2025-39786865,
author = {Holler, Emma and Ludema, Christina and Miled, Zina Ben and Rosenberg, Molly S. and Kalbaugh, Corey Andrew and Boustani, Malaz A. and Mohanty, Sanjay K.},
title = {{Development and Validation of a Routine Electronic Health Record-Based Delirium Prediction Model for Surgical Patients Without Dementia: Retrospective Case-Control Study}},
journal = {JMIR Perioperative Medicine},
year = {2025},
doi = {10.2196/59422},
pmid = {39786865},
url = {https://doi.org/10.2196/59422}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.