Validation of an EEG-based Delirium Monitor in the ICU

Abstract

PurposeDelirium affects around 40% of intensive care unit (ICU) patients and adversely affects survival, length of stay, and cognitive recovery. Despite this, implementation of systematic clinical delirium assessments is variable. We sought to validate a point-of-care electroencephalography (EEG)-based system (Ceribell, Inc.) for the detection of delirium in the ICU.

MethodsIn this multicenter, prospective cohort study, we monitored adult ICU patients with the Ceribell EEG system for 6-8 hours for a minimum of three days. Up to three times per day, expert clinicians assessed participants for delirium and research coordinators completed Confusion Assessment Method for the ICU (CAM-ICU) assessments, which we used to calculate CAM-ICU-7 severity scores. We compared expert clinician diagnoses with Ceribell EEG algorithm output using data from 30-minute periods surrounding each clinician assessment.

ResultsAmong 225 participants analyzed (median age: 64 years, 60% male, 21% mechanically ventilated), expert clinicians performed 857 assessments and found 24% of participants were delirious during at least one assessment. The Ceribell EEG system detected delirium with a sensitivity of 81% (95% CI: 76% to 87%) and specificity of 81% (95% CI: 78% to 84%). The continuous Ceribell EEG system score correlated with CAM-ICU-7 delirium severity scores (bootstrapped median rho 0.58, IQR: 0.54-0.62, p <0.001).

ConclusionIn a mixed adult ICU population, the Ceribell EEG system identified delirium with good sensitivity and specificity. Its continuous output was associated with delirium severity, highlighting its potential ability to characterize underlying physiological patterns across the clinical delirium spectrum.

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BibTeX RIS

BibTeX

@misc{onyemekwu2026validation,
  title = {{Validation of an EEG-based Delirium Monitor in the ICU}},
  author = {C. A. Onyemekwu and S. Karunakaran and M. Armenta Salas and N. T. Prendergast and K. M. Toth and M. D. Miller and S. Lee and B. Kamousi and M. A. Mulkey and F. G. Sadaka and T. Striegel and T. D. Girard},
  howpublished = {medRxiv},
  year = {2026},
  month = sep,
  doi = {10.64898/2026.09.23.26361767},
  url = {https://www.medrxiv.org/content/10.64898/2026.09.23.26361767v1},
  note = {CC BY-NC-ND},
}

RIS

TY  - UNPB
TI  - Validation of an EEG-based Delirium Monitor in the ICU
AU  - C. A. Onyemekwu
AU  - S. Karunakaran
AU  - M. Armenta Salas
AU  - N. T. Prendergast
AU  - K. M. Toth
AU  - M. D. Miller
AU  - S. Lee
AU  - B. Kamousi
AU  - M. A. Mulkey
AU  - F. G. Sadaka
AU  - T. Striegel
AU  - T. D. Girard
PY  - 2026
DA  - 2026/09/23
PB  - medRxiv
DO  - 10.64898/2026.09.23.26361767
UR  - https://www.medrxiv.org/content/10.64898/2026.09.23.26361767v1
AB  - PurposeDelirium affects around 40% of intensive care unit (ICU) patients and adversely affects survival, length of stay, and cognitive recovery. Despite this, implementation of systematic clinical delirium assessments is variable. We sought to validate a point-of-care electroencephalography (EEG)-based system (Ceribell, Inc.) for the detection of delirium in the ICU.  MethodsIn this multicenter, prospective cohort study, we monitored adult ICU patients with the Ceribell EEG system for 6-8 hours for a minimum of three days. Up to three times per day, expert clinicians assessed participants for delirium and research coordinators completed Confusion Assessment Method for the ICU (CAM-ICU) assessments, which we used to calculate CAM-ICU-7 severity scores. We compared expert clinician diagnoses with Ceribell EEG algorithm output using data from 30-minute periods surrounding each clinician assessment.  ResultsAmong 225 participants analyzed (median age: 64 years, 60% male, 21% mechanically ventilated), expert clinicians performed 857 assessments and found 24% of participants were delirious during at least one assessment. The Ceribell EEG system detected delirium with a sensitivity of 81% (95% CI: 76% to 87%) and specificity of 81% (95% CI: 78% to 84%). The continuous Ceribell EEG system score correlated with CAM-ICU-7 delirium severity scores (bootstrapped median rho 0.58, IQR: 0.54-0.62, p <0.001).  ConclusionIn a mixed adult ICU population, the Ceribell EEG system identified delirium with good sensitivity and specificity. Its continuous output was associated with delirium severity, highlighting its potential ability to characterize underlying physiological patterns across the clinical delirium spectrum.
ER  -

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