Delirium Among Critically Ill Patients With Stroke: Prevalence, Severity, and Outcomes

Background Delirium is a common complication of critical illness, but the epidemiology of delirium among stroke patients with critical illness is uncertain. Objectives To assess the prevalence, severity, and short-term outcomes of delirium in adults admitted to a neurocritical care unit with acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Methods A prospective, observational cohort study was conducted in a neurocritical care unit in the United States. Patients were enrolled within 48 hours of stroke symptom onset. Delirium was assessed daily until study day 7 (or until transfer out of the neurocritical care unit) with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the CAM-ICU-7 delirium severity score. Results Overall, 44.4% of patients in the cohort had delirium. Prevalence was higher among patients with intracerebral hemorrhage (38%, 60%, and 32% in patients with acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage, respectively). Mean CAM-ICU-7 score for patients who had delirium was 5.64. Regression analyses showed patients with delirium had more ventilator days (point estimate, 2.59; 95% CI, 0.73-4.44), longer ICU and hospital lengths of stay (point estimates, 3.33 [95% CI, 1.36-5.31] and 6.76 [3.43-10.09], respectively), lower odds of discharge home (odds ratio, 0.42; 95% CI, 0.19-0.94), and higher odds of worse modified Rankin score of 3 or higher at discharge (odds ratio, 2.58; 95% CI, 1.04-6.36). Higher delirium severity resulted in worse outcomes. Conclusions Delirium is common among critically ill stroke patients, especially those with intracerebral hemorrhage, and patients who experience delirium have worse outcomes. Increasing severity of delirium is associated with adverse outcomes.