Development of a clinical score, PANDA, to predict delirium in stroke care unit

Nakamizo, Tomoki; Kanda, Toshie; Kudo, Yoshihisa; Sugawara, Eriko; Hashimoto, Erina; Okazaki, Ayana; Usuda, Makoto; Nagai, Toru; Hara, Hiroshi; Johkura, Ken

doi:10.1016/j.jns.2020.116956

Cited by 10 publications

(32 citation statements)

References 27 publications

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“…So, the association might be mostly because of confounding by stroke severity, rather than the care itself. Indeed, in that study [11], uncomfortable care was correlated with stroke severity. Thus it is unclear whether delirium in acute stroke is attributable to potentially provocative care.…”

Section: Introductionmentioning

confidence: 83%

“…We conducted a prospective study on acute stroke patients who were admitted to the stroke care unit (SCU) of a stroke center in Yokohama, Japan, from December 1, 2016, to August 31, 2017. This study originally planned to develop a clinical model to predict delirium in SCU, and the eligibility was described in the previous report [11]. In essence, the eligible patients were those admitted to the SCU with the diagnosis of acute stroke, 18 years or older, and without stupor, coma, seizure, or delirium.…”

Section: Study Populationmentioning

confidence: 99%

“…We defined the treatments (exposures) in this study as H2A and five modalities of uncomfortable and/or immobilizing care given during the first 24 h: restraint use, prohibited self-transfer, no oral feeding, indwelling catheters, and frequent nighttime care as defined in the previous report [11].…”

Section: Treatmentsmentioning

confidence: 99%

“…The outcome was delirium that developed during the first 5 days of admission. Delirium was assessed by scoring Intensive Care Delirium Screening Checklist (ICDSC) [20], as described in the previous report [11]. To be succinct, the score was recorded twice daily and whenever their consciousness or behaviors changed.…”

Section: Outcomementioning

confidence: 99%

“…Although the preventive effects of the multicomponent approaches have not been confirmed in acute stroke patients [10], we have recently demonstrated that delirium in acute stroke is associated with uncomfortable or immobilizing care, suggesting its causative role [11]. In acute stroke, however, the need for care strongly depends on stroke severity, which is an established risk factor that can predispose patients to delirium [3,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Effects of uncomfortable care and histamine H2-antagonists on delirium in acute stroke: A propensity score analysis

Nakamizo

Kanda²,

Kudo

et al. 2021

Journal of the Neurological Sciences

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Background and purpose: Uncomfortable care and histamine H2 antagonist (H2A) are implicated in precipitating delirium. In acute stroke, however, the need for them depends on stroke severity, an established risk factor for delirium. So, it is unclear whether care or H2A itself is responsible for delirium. We aimed to evaluate their causal effects on delirium in acute stroke patients. Methods: This is a prospective cohort study on acute stroke patients admitted to a stroke care unit. Patients without stupor, coma, sedation, or delirium upon admission were enrolled. The treatment was H2A and five care modalities given during the first 24 h: restraint use, prohibited self-transfer, no oral feeding, indwelling catheters, and frequent nighttime care. The outcome was delirium within 5 days defined as Intensive Care Delirium Screening Checklist ≥4 points. We estimated the relative risk (RR) for delirium with regression models weighted by overlap weights using propensity scores estimated through logistic models incorporating known and potential confounders, including stroke severity. Results: Of the 387 participants, 188 were given at least one care modality and 130 were given H2A. A total of 42 developed delirium. Delirium was significantly associated with prohibited self-transfer (RR 1.7, 95% CI 1.0-3.0), frequent nighttime care (RR 2.1, 95% CI 1.2-3.7), and multiple care modalities (RR 2.4, 95% CI 1.3-4.4), while other care modalities and H2A were not. Conclusions: This study showed possible causal effects of uncomfortable care on delirium and suggests that minimizing it could prevent delirium in acute stroke.

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Section: Introductionmentioning

confidence: 83%

Section: Study Populationmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of uncomfortable care and histamine H2-antagonists on delirium in acute stroke: A propensity score analysis

Nakamizo

Kanda²,

Kudo

et al. 2021

Journal of the Neurological Sciences

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Heart rate variability and delirium in acute non-cardioembolic stroke: a prospective, cross-sectional, cohort study

et al. 2021

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Objectives Delirium is an acute fluctuating disorder of attention and awareness. It is associated with autonomic dysfunction and increased mortality. The primary endpoint of our study was to measure autonomic activity in acute stroke patients, by means of heart rate variability analysis, in order to identify autonomic modifications that can predispose to delirium. Methods Patients were consecutively enrolled from the stroke unit. Inclusion criteria were age ≥ 18 years and diagnosis of stroke with onset within the previous 72 h confirmed by neuroimaging. Exclusion criteria were atrial fibrillation, congestive heart failure, and conditions requiring intensive care unit. Patients were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at baseline, after 72 h, or when symptoms suggesting delirium occurred. For each patient, ECG was recorded at baseline assessment and HRV analysis was conducted on five consecutive minutes of artifact-free ECG traces. Results Fifty-six ECGs were available for analysis. During the study period, 11 patients developed delirium. Patients with and without delirium did not differ for sex, age, severity of stroke, and comorbidities. The delirium group had greater standard deviation of the heart rate (DLR − :9.16 ± 8.28; DLR + : 14.36 ± 5.55; p = 0.026) and lower power spectral density of the HF component (DLR − : 38.23 ± 19.23 n.u.; DLR + : 25.75 ± 8.77 n.u.; p = 0.031). Conclusions Acute non-cardioembolic stroke patients with increased variability of heart rate and decreased vagal control are at risk for delirium.

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Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

et al. 2022

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Delirium is an acute confusional state characterized by altered level of consciousness and attention. Coronavirus Disease 2019 , caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), can manifest itself with this neuropsychiatric disorder. The endpoints of our study were: the frequency of delirium in subjects with COVID-19 pneumonia; the risk factors that predispose to this condition; and the impact of delirium on mortality. Subjects were consecutively enrolled in a Geriatric Unit from January 5th to March 5th, 2021. Inclusion criteria were: diagnosis of SARS-CoV-2 infection, a radiologically documented pneumonia, and the ability of providing informed consent. Exclusion criteria were: absence of radiological evidence of pneumonia, sepsis, and the need of intensive care unit treatment. All subjects were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at least twice per day. In the study cohort (n = 71), twenty patients (28.2%) had delirium. Delirium was present on admission in 11.3%, and occurred during hospitalization in 19.0%. Compared to patients without delirium, patients who developed this neuropsychiatric disorder had a higher mortality rate (35% vs 5.9%) and an increased average hospital length of stay (21 days vs 17 days). In the multivariate analysis delirium was associated with frailty (OR = 2.81; CI = 1.4-5.8) and helmet ventilation (OR = 141.05; CI = 4.3-4663.9). Delirium was an independent predictor of mortality. Nearly a third of subjects (28.2%) had delirium during hospitalization for COVID-19. This finding supports the notion that delirium is a common complication of SARS-CoV2 infection. Since delirium is associated with longer hospital stay, and it is an independent marker of increased mortality, clinicians should assess and prevent it.

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Development of a clinical score, PANDA, to predict delirium in stroke care unit

Cited by 10 publications

References 27 publications

Effects of uncomfortable care and histamine H2-antagonists on delirium in acute stroke: A propensity score analysis

Effects of uncomfortable care and histamine H2-antagonists on delirium in acute stroke: A propensity score analysis

Heart rate variability and delirium in acute non-cardioembolic stroke: a prospective, cross-sectional, cohort study

Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

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