Development and Validation of a Machine Learning‐Based Risk Prediction Model for Delirium in Older Inpatients: A Prospective Cohort Study

AIMS: To develop and validate a machine learning-based risk prediction model for delirium in older inpatients. DESIGN: A prospective cohort study. METHODS: A prospective cohort study was conducted. Eighteen clinical features were prospectively collected from electronic medical records during hospitalisation to inform the model. Four machine learning algorithms were employed to develop and validate risk prediction models. The performance of all models in the training and test sets was evaluated using a combination of the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, Brier score, and other metrics before selecting the best model for SHAP interpretation. RESULTS: A total of 973 older inpatient data were utilised for model construction and validation. The AUC of four machine learning models in the training and test sets ranged from 0.869 to 0.992; the accuracy ranged from 0.931 to 0.962; and the sensitivity ranged from 0.564 to 0.997. Compared to other models, the Random Forest model exhibited the best overall performance with an AUC of 0.908 (95% CI, 0.848, 0.968), an accuracy of 0.935, a sensitivity of 0.992, and a Brier score of 0.053. CONCLUSION: The machine learning model we developed and validated for predicting delirium in older inpatients demonstrated excellent predictive performance. This model has the potential to assist healthcare professionals in early diagnosis and support informed clinical decision-making. IMPACT: By identifying patients at risk of delirium early, healthcare professionals can implement preventive measures and timely interventions, potentially reducing the incidence and severity of delirium. The model's ability to support informed clinical decision-making can lead to more personalised and effective care strategies, ultimately benefiting both patients and healthcare providers. REPORTING METHOD: This study was reported in accordance with the TRIPOD statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.