Trail making test B in postoperative delirium: a replication study

BJA Open, vol. 8, pp. 100239

Abstract

Background The Trail Making Test B (TMT-B) is indicative of cognitive flexibility and several other cognitive domains. Previous studies suggest that it might be associated with the risk of developing postoperative delirium, but evidence is limited and conflicting. We therefore aimed to replicate the association of preoperative TMT-B results with postoperative delirium. Methods We included older adults (≥65 yr) scheduled for major surgery and without signs of dementia to participate in this binational two-centre longitudinal observational cohort study. Presurgical TMT-B scores were obtained. Delirium was assessed twice daily using validated instruments. Logistic regression was applied and the area under the receiver operating characteristic curve calculated to determine the predictive performance of TMT-B. We subsequently included covariates used in previous studies for consecutive sensitivity analyses. We further analysed the impact of outliers, missing or impaired data. Results Data from 841 patients were included and of those, 151 (18%) developed postoperative delirium. TMT-B scores were statistically significantly associated with the incidence of postoperative delirium {odds ratio per 10-s increment 1.06 (95% confidence interval [CI] 1.02–1.09), P =0.001}. The area under the receiver operating characteristic curve was 0.60 ([95% CI 0.55–0.64], P <0.001). The association persisted after removing 21 outliers (1.07 [95% CI 1.03–1.07], P <0.001). Impaired or missing TMT-B data ( n =88) were also associated with postoperative delirium (odds ratio 2.74 [95% CI 1.71–4.35], P <0.001). Conclusions The TMT-B was associated with postoperative delirium, but its predictive performance as a stand-alone test was low. The TMT-B alone is not suitable to predict delirium in a clinical setting. Clinical trial registration NCT02265263. (https://clinicaltrials.gov/ct2/show/results/NCT02265263).

Authors 10

1. Marinus Fislage corresponding

   Humboldt-Universität zu Berlin · National Taiwan University Hospital · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

   Department of Neurology, National Taiwan University Hospital, Taipei, China

   Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

2. Insa Feinkohl

   Witten/Herdecke University · Max Delbrück Center

   Affiliation as printed

   Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany

   Witten/Herdecke University, Faculty of Health/School of Medicine, Witten, Germany

3. Friedrich Borchers

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

   Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

4. Maria Heinrich

   Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany

   Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

   Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

5. Tobias Pischon

   Max Delbrück Center · Berlin Institute of Health at Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany

   Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany

   Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany

6. Dieuwke Swaantje Veldhuijzen Aachen Health Medical and Neuropsychology Unit Leiden Institute for Brain and Cognition

   Leiden University

   Affiliation as printed

   Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands

   Leiden Institute for Brain and Cognition, Leiden, the Netherlands

7. Arjen J. C. Slooter

   Vrije Universiteit Brussel · Utrecht University · University Medical Center Utrecht · Universitair Ziekenhuis Brussel

   Affiliation as printed

   Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

   Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium

   Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

   UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

8. Claudia Spies

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

   Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

9. Georg Winterer

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

   Pharmaimage Biomarker Solutions GmbH, Berlin, Germany

   Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

10. Norman Zacharias

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany

    Pharmaimage Biomarker Solutions GmbH, Berlin, Germany

    Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany