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Delirium Among Critically Ill Patients With Stroke: Prevalence, Severity, and Outcomes
Thomas N Lawson1, Alai Tan2, Molly McNett3
1Thomas N. Lawson is a lead advanced practice provider, Neurocritical Care Unit, The Ohio State University Wexner Medical Center, The Ohio State University College of Nursing, Columbus.
Summary
Delirium is prevalent in critically ill stroke patients, particularly those with intracerebral hemorrhage. Experiencing delirium is linked to poorer outcomes and increased severity, impacting recovery and hospital stay.
Area of Science:
- Neurocritical care
- Critical illness complications
- Neurology
Background:
- Delirium is a frequent complication in critical illness.
- Epidemiology of delirium in critically ill stroke patients remains unclear.
Purpose of the Study:
- Assess delirium prevalence, severity, and short-term outcomes.
- Focus on adults in a neurocritical care unit with acute ischemic stroke, intracerebral hemorrhage, or aneurysmal subarachnoid hemorrhage.
Main Methods:
- Prospective, observational cohort study in a US neurocritical care unit.
- Patients enrolled within 48 hours of stroke symptom onset.
- Daily delirium assessment using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and CAM-ICU-7 severity score until study day 7.
Main Results:
- Overall delirium prevalence was 44.4%.
- Higher prevalence observed in intracerebral hemorrhage (60%) compared to acute ischemic stroke (38%) and aneurysmal subarachnoid hemorrhage (32%).
- Delirium associated with increased ventilator days, longer ICU/hospital stays, reduced odds of discharge home, and higher odds of worse functional outcomes (modified Rankin score ≥3).
Conclusions:
- Delirium is common in critically ill stroke patients, especially with intracerebral hemorrhage.
- Delirium is associated with significantly worse short-term outcomes.
- Increasing delirium severity correlates with adverse outcomes.
