Prevalence for delirium in stroke patients: A prospective controlled study

Nydahl, Peter; Bartoszek, Gabriele; Binder, Andreas; Paschen, Laura; Margraf, Nils G.; Witt, Karsten; Ewers, Andre

doi:10.1002/brb3.748

Cited by 35 publications

(16 citation statements)

References 30 publications

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“…The results of our study showed no difference in nicotine use between patients with and without delirium and smoking was not a risk factor for post-stroke delirium. In a case–control study performed by Nydahl et al, analysis matched for dementia, severe neurological disability on admission, increased age ≥72 year., and increased CRP on admission showed that delirious patients had more complications but not a worse outcome except a tendency for a reduced rehabilitation improvement, compared to control patients without delirium 32…”

Section: Discussionmentioning

confidence: 87%

<p>Characteristics, Risk Factors And Outcome Of Early-Onset Delirium In Elderly Patients With First Ever Acute Ischemic Stroke - A Prospective Observational Cohort Study</p>

Kotfis¹,

Bott-Olejnik²,

Szylińska³

et al. 2019

CIA

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IntroductionPost-stroke delirium is a common clinical problem, occurring in 10% to 48% of patients. It has been associated with longer hospitalization times, increased mortality and worse functional outcome. In early phase of stroke, it may be regarded as particularly difficult to differentiate from other neurological symptoms. For practical purposes, there is a need to identify simple pre-operative laboratory parameters that may aid delirium diagnosis early after stroke. Our aim was to identify the incidence of early-onset (first 24 hrs) post-stroke delirium, its risk factors and outcomes (complications and mortality) in patients with first-ever acute ischemic stroke (AIS).Material and methodsA retrospective analysis of a prospective observational study (NCT03944694) was performed. Patients were screened for delirium using CAM-ICU method. Clinical and laboratory data were collected, including baseline inflammatory parameters.ResultsFinal analysis included 760 patients, 121 (15.9%) developed delirium. Patients with delirium were older (75.9±13.5 years, p<0.001). Most common complications in the delirium group were pulmonary (57.8% vs 21.4%, p<0.001), cardiac (38.8% vs 13.6%, p<0.001) and renal (13.2% vs 7.5%, p=0.038). Neutrophil-to-lymphocyte ratio (NLR) (6.71±9.65 vs 4.55±5.51, p<0.001), C-reactive protein level (32.59±65.94 vs 15.70±38.56, p<0.001) and troponin T level (72.59±180.15 vs 26.85±77.62, p<0.001) were higher in delirious patients and platelet-to white blood cell count ratio (PWR) (23.42±9.51 vs 27.13±10.58, p<0.001) was lower. Multivariable logistic regression showed that atrial fibrillation (OR 1.651, p=0.049), higher Rankin score on admission (OR 1.689, p<0.001), hemianopia (OR 2.422, p=0.003) and PWR <20.22 (OR 2.197, p=0.002) were independently associated with delirium. Kaplan–Meier curves indicated that mortality increased for patients with delirium at 3 months (p<0.001) and 1 year (p<0.001) after AIS.ConclusionAtrial fibrillation, higher Rankin score, hemianopia and lower PWR were independently associated with early onset delirium in patients with first ever AIS. This confirms that deprivation of senses and early generalized inflammatory response are critical for delirium development.

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Section: Discussionmentioning

confidence: 87%

<p>Characteristics, Risk Factors And Outcome Of Early-Onset Delirium In Elderly Patients With First Ever Acute Ischemic Stroke - A Prospective Observational Cohort Study</p>

Kotfis¹,

Bott-Olejnik²,

Szylińska³

et al. 2019

CIA

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“…Overall incidence of delirium is very high in NCCU. 15 Delirious patients have more complications and may have even worse rehabilitation. AI-enabled data analysis could improve detection of delirium and enable real-time intervention to improve sleep hygiene.…”

Section: Ai Wouldmentioning

confidence: 99%

Artificial Intelligence in Neurointensive Care Unit: A Cautious Leap into Future

Bithal

2020

Journal of Neuroanaesthesiology and Critical Care

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“…Aphasia is present in about one-third of all patients with acute stroke in varying forms and severity 3–5. Though evidence on the prevalence of severe confusion is not available, the prevalence of a formally diagnosed delirium lies around 10% 6 7. With about 41 300 patients with stroke per year in the Netherlands, this would annually mean 13 800 patients with aphasia and 4130 patients with delirium during the acute phase of stroke 8…”

Section: Introductionmentioning

confidence: 99%

“…It is a Dutch scale with 10 behaviours that may indicate the presence of pain 13. As patients with stroke and specifically patients with aphasia or delirium tend to be older, this scale seems appropriate for the use in acute stroke care 7 14 15…”

Section: Introductionmentioning

confidence: 99%

How incremental video training did not guarantee implementation due to fluctuating population prevalence

et al. 2019

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Patients with stroke admitted at the neurology/neurosurgery ward of the Academic Medical Centre in Amsterdam, The Netherlands, may experience problems in communication, such as aphasia, severe confusion/delirium or severe language barriers. This may prevent self-reported pain assessment; therefore, pain behaviour observation scales are needed. In this project, we therefore aimed to implement the Rotterdam Elderly Pain Observation Scale (REPOS) by video training.We used a stepped-wedge cluster design with clusters of four to five nurses with intervals of 2 weeks, for a total study duration of 34 weeks. Primary endpoint was the proportion of shifts in which nurses used the REPOS when caring for an eligible patient. A questionnaire was send biweekly to assess self-perceived competence and attitude on pain measurement in patients able or unable to self-report pain intensity. No other strategies were used to promote the use of the REPOS.Though the proportion of shifts in which trained nurses cared for eligible patients increased from 0% at baseline to 83% at the end of the study, the proportion of cumulative shifts where the REPOS was used decreased from 14% to 6%, respectively. Process evaluation suggests that this decrease can (in part) be attributed to low and varying prevalence of eligible patients and opportunities for practice. In total, 24 (45.3%) nurses had used the REPOS at least once after 34 weeks, with a median of two times (1–33). Nurses perceived themselves 'competent' to 'very competent' in pain behaviour observation. There was no negative attitude towards pain measurement.This study shows that education alone may not be effective when implementing a pain behaviour observation scale for non-communicative patients with Acquired Brain Injury. Individual motivation of health professionals and individual patient factors may be of influence for the use of the REPOS.

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Prevalence for delirium in stroke patients: A prospective controlled study

Abstract: Background and Purpose: This study investigates the prevalence of delirium in acute

Cited by 35 publications

References 30 publications

<p>Characteristics, Risk Factors And Outcome Of Early-Onset Delirium In Elderly Patients With First Ever Acute Ischemic Stroke - A Prospective Observational Cohort Study</p>

<p>Characteristics, Risk Factors And Outcome Of Early-Onset Delirium In Elderly Patients With First Ever Acute Ischemic Stroke - A Prospective Observational Cohort Study</p>

Artificial Intelligence in Neurointensive Care Unit: A Cautious Leap into Future

How incremental video training did not guarantee implementation due to fluctuating population prevalence

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