Towards a predictive model for post-stroke delirium

Košťálová, Milena; Bednařík, Josef; Mitášová, Adéla; Dušek, Ladislav; Michalčáková, Radka Neužilová; Keřkovský, Miloš; Kašpárek, Tomáš; Ježková, Martina; Balabánová, Petra; Voháňka, Stanislav

doi:10.3109/02699052.2012.660510

Cited by 33 publications

(58 citation statements)

References 33 publications

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“…Regarding incidence of delirium and type of stroke, we found that delirium is more prevalent in patients with cerebral hemorrhage compared to patients with ischemic stroke. This was in line with previous studies [26,29,30,34].…”

Section: Discussionsupporting

confidence: 93%

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Assessment of the risk factors and functional outcome of delirium in acute stroke

Zaitoun

El-Sayed

Ramadan

2019

Egypt J Neurol Psychiatry Neurosurg

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Background: Post stroke delirium is a multifactorial life-threatening process, still poorly understood. The aim of the study was to identify the risk factors associated with the development of delirium in acute stroke patients and detection of the effect of delirium on the short-term prognosis of acute stroke patients.Patients and methods: This study was carried on 74 acute stroke patients, 40 males (54.1%) and 34 females (45.9%). Full general and neurological examination was performed to all patients. Full routine laboratory investigation and computed tomography scan and/or magnetic resonance imaging of the brain were done. Results: The patients were divided into two groups: 15 patients with delirium (group I) and 59 patients without delirium (group II). The incidence of delirium was higher among patients with older age (P = 0.002). There was no statistically significant relationship between incidence of delirium and sex of patients (P = 0.52). The delirium patients had significantly higher National Institutes of Health Stroke Scale (NIHSS) (P = 0.001) and lower Glasgow Coma Scale (GSC) (P = 0.001) at admission. They also had high mortality (P = 0.017) and lower Barthel Index (BI), and these results were statistically (P = 0.001) significantly. Conclusion: Post stroke delirium was associated with old age, higher NIHSS at admission, intracerebral hemorrhage, and higher long-term mortality.

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Section: Discussionsupporting

confidence: 93%

“…A highly significant relationship was found between the development of delirium and presence of severe neurological impairment at admission (NIHSS > 15). This was in agreement with results carried out by [32,34]. Lower GCS and higher NIHSS at admission have been used as predictors of stroke severity.…”

Section: Discussionsupporting

confidence: 91%

Assessment of the risk factors and functional outcome of delirium in acute stroke

Zaitoun

El-Sayed

Ramadan

2019

Egypt J Neurol Psychiatry Neurosurg

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“…The second study used admission CT and MRI 4–6 weeks later (for haemorrhagic transformation) in ischaemic and haemorrhagic stroke ( N = 100). Higher incidence of delirium was associated with intracerebral haemorrhage (OR 6.11, 95%CI 1.62–22.98) and total anterior circulation infarction (OR 6.66, 95%CI 1.85–24.01; Kostalova et al, ).…”

Section: Structural Neuroimagingmentioning

confidence: 96%

“…Three studies evaluated the relationship between stroke characteristics and delirium in 716 patients of whom 130 had delirium. Two studies used semi‐automated software for volumetric analysis (Kostalova et al, ; Naidech et al, ), one assessed stroke locations visually (Oldenbeuving et al, ) using published criteria (Mead et al, ; Oldenbeuving et al, ).…”

Section: Structural Neuroimagingmentioning

confidence: 99%

A systematic review of neuroimaging in delirium: predictors, correlates and consequences

Nitchingham

Kumar

Shenkin

et al. 2017

Int J Geriat Psychiatry

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Neuroimaging is now used more widely in delirium research due to advances in technology. However, imaging delirious patients presents challenges leading to methodological limitations and restricted generalisability. The findings that atrophy and WMH burden predict delirium replicates findings from the original review, while advanced techniques have identified other substrates and mechanisms that warrant further investigation.

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“…In our survey, only two respondents reported using the CAM-ICU, which might increase the proportion of patients with language difficulties who may be assessable [55] as the CAM-ICU does not rely on language for the diagnosis of delirium [49,56]. This tool has recently been validated for use in stroke patients, demonstrating high sensitivity, specificity, overall accuracy, and inter-rater reliability [14,57]. Various ISRN Stroke 5 authors, in both nursing and medical literature are calling for clinicians to take a key role in the identification of delirium in practice, advocating the use of validated instruments to facilitate accurate and timely recognition, leading to prompt treatment and better outcomes for patients [5,14,28,58].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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Towards a predictive model for post-stroke delirium

Abstract: Higher age, metabolic disturbances, intracerebral haemorrhage and larger ischemic hemispheric strokes increase the risk of post-stroke delirium.

Cited by 33 publications

References 33 publications

Assessment of the risk factors and functional outcome of delirium in acute stroke

Assessment of the risk factors and functional outcome of delirium in acute stroke

A systematic review of neuroimaging in delirium: predictors, correlates and consequences

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

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