Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review

Abstract

Abstract:Background and purpose: Delirium is a common complication in acute stroke yet there is uncertainty regarding how best to screen for and diagnose delirium after stroke. We sought to establish how delirium after stroke is identified, its incidence rates and factors predicting its development. Methods: We conducted a systematic review of studies investigating delirium in acute stroke. We searched The Cochrane Collaboration, MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, British Nursing Index, PEDro and OT Seeker in October 2010.Results: 3127 citations were screened, full text of 60 titles and abstracts were read, of which 20 studies published between 1984 and 2010 were included in this review. The methods most commonly used to identify delirium were generic assessment tools such as the Delirium Rating Scale (n=5) or the Confusion Assessment Method (n=2) or both (n=2). The incidence of delirium in acute stroke ranged from 2.3% to 66%, with our meta-analysis random effects approach placing the rate at 26% (95% CI: 19-33). Of the 11 studies reporting risk factors for delirium, increased age, aphasia, neglect or dysphagia, visual disturbance and elevated cortisol levels were associated with the development of delirium in at least one study. The outcomes associated with the condition are increased morbidity and mortality. Conclusions: Delirium is found in around 26% of stroke patients. Difference in diagnostic and screening procedures could explain the wide variation in frequency of delirium. There are a number of factors that may predict the development of the condition. Title: Delirium in acute stroke: screening tools, incidence rates and predictors -a systematic review. Suggested Reviewers: Powered by Editorial Manager® and Preprint Manager® from Aries Systems Corporation Authors AbstractBackground and purpose Delirium is a common complication in acute stroke yet there is uncertainty regarding how best to

Prevalence for delirium in stroke patients: A prospective controlled study

“…Prevalence of delirium is 10.7%, giving a lower prevalence than 26% in a recent meta-analysis (Carin-Levy et al, 2012). There are different hypothesis' to explain this result.…”

“…The etiology of delirium is complex, and current theories explain its development by interaction of hypoxia, inflammatory processes, disturbance of neurotransmitter, and the presence of internal or external risk factors (Riedel, Browne, & Silbert, 2014). The prevalence of delirium in patients after stroke is estimated to average 26% (Carin-Levy, Mead, Nicol, Rush, & van Wijck, 2012). A delirium increases the risks for mortality, complications, longer length of hospital stay, and institutionalization (Shi, Presutti, Selchen, & Saposnik, 2012).…”

Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

“…Our systematic review [4] identified a number of tools commonly mentioned in the literature; however, the most frequently cited are the Delirium Rating Scale (DRS) [25] and the CAM [24], both of which are based on the American Psychiatric Association diagnostic and statistical manual (DSM) criteria and designed to identify delirium across a variety of medical settings. The DRS was designed to be used by medical staff with specific training [25].…”

“…In acute stroke, the incidence of delirium reported by individual studies ranges from 10% [2] to 48% [3], and meta analyses recently performed placed the incidence around 26%-28% [4,5]. Delirium is associated with increased mortality, morbidity, and length of hospital stay [5][6][7][8], and it has been strongly associated with development of cognitive impairment in the long term in the general medical setting [9,10].…”

“…Delirium is associated with increased mortality, morbidity, and length of hospital stay [5][6][7][8], and it has been strongly associated with development of cognitive impairment in the long term in the general medical setting [9,10]. In acute stroke, recent studies have clearly demonstrated that patients who develop delirium are more likely to die within 12 months, have poorer functional outcomes, and are at higher risk of developing dementia [4,5,11,12]. There are calls in the literature for clinicians to place an emphasis on early identification of delirium in stroke patients, using a tool validated specifically for this population, as early intervention may minimise the aforementioned unfavourable outcomes [5,13,14].…”