Delirium Assessment in Acute Stroke: A Systematic Review and Meta-Analysis of Incidence, Assessment Tools, and Assessment Frequencies

Abstract

Purpose: The purpose of this systematic literature review was to examine whether different assessment methods contribute to the variance in delirium incidence detected in populations of patients with acute stroke. Specifically, the aim was to address the influence of (1) choice of assessment tool, (2) frequency of assessment, and (3) type of health professional doing the assessment. Methods: We searched MEDLINE, EMBASE, and PsycINFO and included pro- and retrospective cohort studies assessing delirium during hospitalization of adult acute stroke patients. Results: In 30 articles, 24 unique populations were identified and included in the review. Delirium incidence ranged from 1.4% to 75.6% in total and a chi-square test showed a significant heterogeneity across studies (χ2 = 536.5, df = 23, P < .0001). No studies had an assessment for delirium before a patient entered the study. No specific patterns regarding the influence of tool, assessment frequency or health professional were discernible. Discussion: Subgroups analyses were not conducted due to the heterogeneity across studies. Studies comparing delirium assessment tools directly with each other are needed. Conclusions: Delirium is a common complication in acute stroke. No firm conclusions about a possible correlation of choice of tool, assessment frequency, and delirium incidence could be made due to the great heterogeneity of the study populations. Only 1 study compared 2 tools directly with each other. Further studies comparing delirium assessment tools directly with each other are needed.

Delirium in acute stroke: A prospective, cross‐sectional, cohort study

“…Also the severity of stroke, expressed as NIHSS score, and prestroke mRS score were associated with delirium, which is in line with previous studies [10]. In our cohort, comorbidities that were predictors of delirium were: atrial fibrillation, [32] cognitive impairment, [31] use of drugs acting on the CNS prior to hospital admission, [33,34] and leukoencephalopathy [35]. Interestingly, age was not associated with delirium, apparently in contrast with literature data.…”

“…Unexpectedly, our study showed that stroke patients affected by COPD were more prone to developing delirium. COPD is not cited among the risk factors for delirium in most of the studies analyzed in systematic reviews and meta‐analysis [13,33‐35]. Also, a recent study in a large population of stroke patients did not report COPD as a risk factor for delirium [13].…”

“…Unexpectedly, our study showed that stroke patients affected by COPD were more prone to developing delirium. COPD is not cited among the risk factors for delirium in most of the studies analyzed in systematic reviews and meta-analysis [13,[33][34][35].…”

Facial skin temperature in acute stroke patients with delirium - A pilot study

“…It should be appreciated that the delirium incidence of 12.5% in our study is relatively low compared to delirium incidences found in stroke populations in three systematic reviews [17,39,40]. The patients in our study had relatively minor strokes based on their NIHSS scores which may in part explain why the delirium incidence was relatively low.…”

“…Acute stroke is often complicated by delirium [17] which pathophysiologically may be associated with changes in the sympathetic part of the autonomic nervous system [18][19][20][21][22]. We therefore hypothesized that changes in skin temperature may be linked to development of delirium in patients with acute stroke.…”