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Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes

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Abstract

Background

Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study.

Methods

We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton IADL (Instrumental Activities of Daily Living) scores. Independent predictors were identified using logistic regression.

Results

From 309 SAH patients admitted between January 2011 and December 2015, 52 (17 %) developed agitation, frequently in the first 72 h (50 %) and in patients with Hunt–Hess grades 3–4 (12 % of grades 1–2, 28 % of grades 3–4, 8 % of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications; and in half of these patients, complications were diagnosed within 24 h of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95 % CI, 1.1–6.8) in non-comatose patients (Hunt–Hess 1–4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors.

Conclusion

Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications and may have an independent impact on long-term outcomes.

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Acknowledgments

This publication was supported by the DANA Foundation (JC, JMS), the NLM of the NIH under Award Number R01 LM011826 (JC), and NIH Grant K01 ES026833 (SP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA

    Michael E. Reznik, J. Michael Schmidt, Ali Mahta, Sachin Agarwal, David J. Roh, Soojin Park, Hans Peter Frey & Jan Claassen

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  1. Michael E. Reznik
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Correspondence to Jan Claassen.

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Dr. Claassen reported receiving honoraria from serving on the Advisory Board of SAGE for study development.

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Reznik, M.E., Schmidt, J.M., Mahta, A. et al. Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes. Neurocrit Care 26, 428–435 (2017). https://doi.org/10.1007/s12028-016-0331-1

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