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Delirium after acute stroke associated with higher inpatient mortality
Shi Q. Stroke. 2012;doi:10.1161/STROKEAHA.111.643726.
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One-third of patients admitted with acute stroke develop delirium, which is associated with higher mortality, longer hospitalization and dependency after discharge, according to results of a recent study.
Through a literature search, researchers completed a systematic review and meta-analysis of the incidence risk for delirium in patients with acute stroke. Ten prospective cohort studies with 2,004 patients were reviewed. Researchers defined the primary endpoint as inpatient mortality and secondary endpoint as mortality at 12 months.
Incidence of delirium in stroke patients
Study results showed the incidence of delirium ranged from 10% to 48%. Six studies reporting on the incident of inpatient mortality showed that the risk for inpatient mortality was higher among patients with delirium vs. nondelirious patients (OR=4.71; 95% CI, 1.85-11.96). Patients with delirium also experienced higher rates of mortality at 12 months, according to results of three studies comparing patients with and without delirium (OR=4.91; 95% CI, 3.18-7.6). Patients with delirium after stroke were almost five times more likely to die within 12 months.
Four studies reporting discharge destination after hospitalization showed that patients with delirium remain hospitalized 9 days longer, on average (95% CI, 6.67-12.11), and also were discharged to long-term care institutions or nursing homes more often than nondelirious patients (OR=3.39; 95% CI, 2.21-5.21).
Infection, substance abuse, metabolic abnormalities, renal failure, HF or medicines can trigger delirium in patients with stroke, according to a press release. Also, stroke patients who experience delirium tend to be older, have more medical problems and experience larger strokes.
However, Gustavo Saposnik, MD, MSc, director of the Stroke Outcomes Research Center at St. Michael’s Hospital in Toronto, said results could not be adjusted for stroke severity or accompanying illnesses, which may influence outcomes. “Most of the patients were in stroke units at academic hospitals, so their condition could be more complex and result in poorer outcomes than those in community hospitals,” Saposnik said.
Management of stroke, delirium
Overall, the researchers said the study results have practical implications for the management of stroke patients with delirium and can provide counseling to families and policymakers after a patient experiences an acute stroke.
“Delirium affects more than one-quarter of people who suffer a stroke,” Saposnik told Cardiology Today. “Suffering delirium adds more distress to stroke patients and their families. For example, patients may become confused, disoriented or agitated, experience hallucinations, may not be able to recognize family members.”
Clinicians are encouraged to use tools to identify early signs and recognize modifiable risk factors of delirium. “Early intervention might increase the chance of being discharged to home after stroke, maintaining independence, and a good quality of life,” the researchers said.
Disclosure: Dr. Saposnik reports no relevant financial disclosures.
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Delirium can occur in patients with a recent stroke from a variety of potential causes including medications, infections and concomitant illnesses in addition to the effects of the stroke itself. The development of delirium can impair post-stroke recovery by limiting the initiation and intensity of physiotherapeutic interventions. Medications used to treat the symptoms of delirium could also be harmful as the brain recovers from the injury. Identifying and treating potential causes of delirium are of paramount importance.
– Larry B. Goldstein, MD, FAAN,
FAHA
Cardiology Today Editorial Board member
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