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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.
Background:
Delirium is a common complication of critical illness, but the epidemiology of delirium among stroke patients with critical illness is uncertain.
Objectives:
To assess the prevalence, severity, and short-term outcomes of delirium in adults admitted to a neurocritical care unit with acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage.
Methods:
A prospective, observational cohort study was conducted in a neurocritical care unit in the United States. Patients were enrolled within 48 hours of stroke symptom onset. Delirium was assessed daily until study day 7 (or until transfer out of the neurocritical care unit) with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the CAM-ICU-7 delirium severity score.
Results:
Overall, 44.4% of patients in the cohort had delirium. Prevalence was higher among patients with intracerebral hemorrhage (38%, 60%, and 32% in patients with acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage, respectively). Mean CAM-ICU-7 score for patients who had delirium was 5.64. Regression analyses showed patients with delirium had more ventilator days (point estimate, 2.59; 95% CI, 0.73-4.44), longer ICU and hospital lengths of stay (point estimates, 3.33 [95% CI, 1.36-5.31] and 6.76 [3.43-10.09], respectively), lower odds of discharge home (odds ratio, 0.42; 95% CI, 0.19-0.94), and higher odds of worse modified Rankin score of 3 or higher at discharge (odds ratio, 2.58; 95% CI, 1.04-6.36). Higher delirium severity resulted in worse outcomes.
Conclusions:
Delirium is common among critically ill stroke patients, especially those with intracerebral hemorrhage, and patients who experience delirium have worse outcomes. Increasing severity of delirium is associated with adverse outcomes.
