Delirium affects up to a third of stroke patients

25 January 2012

MedWire News: Delirium may occur in up to three in 10 patients with acute stroke, say the authors of a systematic review and meta-analysis.

“The presence of delirium early after admission for an acute stroke represents a diagnostic dilemma and aggravates the family distress,” comment Gustavo Saposnik (University of Toronto, Ontario, Canada) and colleagues.

The prevalence of delirium in the team’s analysis ranged from 10% to 48%. This was drawn from 10 studies with 2004 patients, but one study contributed a particularly high rate of delirium; excluding this reduced the upper limit to 28%. The large difference between this and the other studies was down to methodologic differences, say Saposnik et al.

Six of the included studies looked at the impact of delirium on inpatient mortality, finding that its presence raised this risk 4.7-fold overall. The three studies that looked at 12-month mortality reported an overall 4.9-fold increased risk among patients with versus without delirium.

Delirium also influenced discharge destination, with patients who developed delirium being 3.4-fold more likely than other patients to be discharged to long-term or nursing care, rather than short-term facilities or their own homes (based on four studies).

Six studies reported that patients with delirium remained in hospital longer than those without. “Because stroke patients with delirium usually require further medical investigations, it is not surprising they had a longer length of hospital stay,” comment the researchers.

Writing in Stroke, they say that the findings have “practical implications for the management of stroke patients” with delirium. They urge clinicians to screen stroke patients for delirium and related modifiable risk factors.

“Early screening for delirium and the identification of a metabolic or infectious condition should prompt the appropriate treatment and consequently improve clinical outcomes,” say Saposnik et al.

“Early intervention might increase the chance of being discharged to home after stroke, maintaining independence, and a good quality of life.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

Stroke 2012; Advance online publication