A Scoping Review of the Incidence, Predictors, and Outcomes of Delirium Among Critically Ill Stroke Patients

Abstract

BACKGROUND: Delirium is a common, often iatrogenically induced syndrome that may impede the physical, cognitive, and psychological recovery of critically ill adults. The effect delirium has on outcomes of intensive care unit patients having acute neurologic injury remains unclear because previous studies frequently exclude this vulnerable population. The aim of this scoping review was to describe the incidence, predictors, and outcomes of delirium among adults admitted to an intensive care unit experiencing an acute ischemic stroke, intracerebral hemorrhage, or aneurysmal subarachnoid hemorrhage. METHODS: PubMed, CINAHL, Web of Science, EMBASE, and Scopus were searched with the terms (1) stroke, (2) critical care, and (3) delirium. Inclusion criteria were original peer-reviewed research reporting the incidence, outcomes, or predictors of delirium after acute stroke among critically ill adults. Editorials, reviews, posters, conference proceedings, abstracts, and studies in which stroke was not the primary reason for admission were excluded. Title and abstract screening, full-text review, and data extraction were performed by 2 authors, with disagreements adjudicated by a third author. RESULTS: The initial search yielded 1051 results. Eighteen studies met eligibility criteria and were included in the review. Stroke type was not mutually exclusive and included persons given a diagnosis of acute ischemic stroke (11), intracerebral hemorrhage (12), aneurysmal subarachnoid hemorrhage (8), and other (1) strokes. Incidence of delirium among stroke patients ranged from 12% to 75%. Predictors of delirium included older age, preexisting dementia, higher severity of illness, and physical restraint use. Outcomes associated with delirium included higher mortality, longer length of stay, worse cognition and quality of life, and lower functional status. CONCLUSIONS: Current findings are limited by heterogenous populations, assessments, and measurement parameters. Detection and management of delirium among critically ill stroke patients requires an approach with specific considerations to the complexities of acute neurological injury and concomitant critical illness.

Bringing Delirium to Light

“…Early detection of delirium may have contributed to the minimal utilization of high-risk medication that can cause delirium. The authors acknowledge several potential confounding variables, such as case mix index, age, gender, medication regimen, and mobility status, all of which can affect the LOS of CCU patients (Lawson et al., 2022). Knowing that a propensity score matching was not used in the project, the result is inconclusive to determine if the CAM-ICU tool may decrease the LOS.…”

Associations of Delirium to Posthospital Outcomes After Acute Stroke: A Scoping Review

“…Limited validation of frequently used delirium screening instruments exists for use in neuroscience patient populations, and there is lack of consensus surrounding their use. 10,[37][38][39] Better validation of delirium screening instruments could help to standardize neuroscience nursing practice in concordance with recommendations for nonneurological patient populations. More standardized data collection throughout hospitalization could inform real-time nursing interventions and would improve understanding of poststroke delirium prevalence, severity, and impact on posthospital outcomes.…”

Family Presence May Reduce Postoperative Delirium After Spinal Surgery

“…Delirium is a common phenomenon experienced by patients in many hospital settings. 1 Delirium is burdensome to patients, families, clinicians, and support and healthcare systems. 2 Although research on intensive care unit (ICU) delirium has become more prevalent in nursing literature, a current gap is the impact of family presence on delirium in the early postoperative (postop) period.…”

“…Delirium is a common phenomenon experienced by patients in many hospital settings 1. Delirium is burdensome to patients, families, clinicians, and support and healthcare systems 2.…”