Newswise — Delirium affected 44% of critically ill patients in an Ohio medical center who were hospitalized after a recent stroke, according to new research published in American Journal of Critical Care (AJCC).
Incidence rates were highest for patients with intracerebral hemorrhage (ICH), with 60% having delirium for at least one day.
The prospective, observational cohort study was conducted in the neurosciences critical care unit (NCCU) at The Ohio State University (OSU) Wexner Medical Center, Columbus. The 16-bed NCCU is part of the hospital’s Comprehensive Stroke Center and the only unit in Central Ohio with comprehensive specialized monitoring capabilities for neurological functions.
“Delirium Among Critically Ill Patients With Stroke: Prevalence, Severity, and Outcomes” is among the first studies to look at delirium in a cohort of only critically ill patients hospitalized because of a stroke.
Co-author Thomas Lawson, PhD, APRN-CNP, ACNP-BC, is a lead advanced practice provider in the NCCU. Researchers from the medical center and OSU College of Nursing contributed to the work.
“The occurrence of delirium alone was associated with a variety of adverse outcomes and longer stays for stroke patients, with those having higher delirium severity also experiencing the worst outcomes,” he said. “By focusing exclusively on patients who were critically ill after a stroke, our study provides important insight into the association between delirium and adverse outcomes among stroke patients, further underscoring the importance of delirium prevention and treatment.”
Having had delirium, even for a single day, was associated with more days receiving mechanical ventilation, longer length of stay, lower likelihood of discharge to home and higher odds of a score of 3 or higher on the modified Rankin Scale (mRS) at discharge, indicating an unfavorable outcome.
Mortality rates, both while in the NCCU and prior to discharge from the hospital, were not significantly different between those who ever had delirium and those who had not.
Between January and December 2022, the researchers assessed 269 patients for possible eligibility, and the final analysis included data from 169 patients. More than half had recently experienced acute ischemic stroke (AIS, 54.7%), with a third diagnosed with ICH (34.7%) and the remainder diagnosed with aneurysmal subarachnoid hemorrhage (aSAH, 11.2%).
Trained study staff assessed each participating patient for delirium daily for up to seven days while patients were in the NCCU. Delirium was measured with the Confusion Assessment Method for the ICU (CAM-ICU-7), a seven-point delirium severity tool. Patients deemed to have delirium for at least one day were included in the delirium numbers.
To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.
About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of about 130,000 acute and critical care nurses and can be accessed at www.ajcconline.org.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme
