Occurrence Rates of Delirium in Brain Tumor Patients: A Systematic Review and Meta-Analysis

Background: The occurrence (incidence or prevalence) of delirium in brain tumors is unknown, yet delirium is associated with increased morbidity and mortality and worse quality of life. We conducted a systematic review and meta-analysis to determine the occurrence of delirium in hospitalized patients with brain tumors. Methods: PubMed, Scopus, and Web of Science were systematically searched for papers from 1 January 1999 to 12 July 2024, including references from texts. Cross-sectional, prospective, and other cohort study designs were included, and individual case reports, case series, editorials, and reviews were excluded. The included papers were scored using a validated sensitivity analysis tool and tested for quality and bias using funnel plots and Egger's test. We used random effects models for the summary estimates. We performed subgroup analyses by tumor type, tumor location, delirium subtype, and length of stay. Results: Of the 452 studies screened, 27 were included, representing 35,958 patients. The overall occurrence of delirium was 0.17 (95% CI [0.11-0.24]). Delirium occurrence in patients with low-grade gliomas, high-grade gliomas, and brain metastases was 0.10 [0.06-0.16], 0.21 [0.10-0.40], and 0.31 [0.16-0.50], respectively. Compared to the occipital lobe, there was a higher occurrence of delirium for tumors in the frontal (RR 3.08 [1.35-8.22]) and temporal lobes (RR 2.88 [1.22-7.93]). The patients were more likely to have hypoactive (RR 1.61 [1.30; 1.98]) than hyperactive delirium. Delirium was associated with 4.62 additional hospitalized days compared to those without delirium (CI [3.23-6.01]). Discussion: We confirmed high occurrence rates of delirium in patients hospitalized with brain tumors. Patients with brain metastases had a higher occurrence of delirium compared to patients with gliomas, and delirium occurrence rates were higher in patients with frontotemporal tumors. Delirium occurrence rates in the literature are very heterogeneous and point toward a need for tailored assessments in patients with brain tumors.