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

Abstract

Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a webbased survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.

Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study

“…At CCDHB, concerns were raised about the appropriateness of the 4AT and delirium pamphlets on stroke and stroke rehabilitation wards. These concerns were similar to those voiced in a previous survey, where 87% of stroke practitioners were not sure, or did not believe, that delirium tools were appropriate in acute stroke, and many found them particularly challenging to complete in aphasia [35]. We addressed these concerns by emphasising the prevalence of delirium and the validity of the 4AT in acute stroke.…”

Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study

“…Delirium screening is challenging if speech comprehension or speech production are impaired. In a survey of healthcare providers working in acute stroke, the majority of respondents reported difficulties using delirium screening tools in aphasic patients (15). Furthermore, patients with aphasia have previously been excluded from a number of studies on post-stroke delirium, leading to exclusion bias (16).…”