Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review
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Delirium is a common complication in acute stroke yet there is uncertainty regarding how best to screen for and diagnose delirium after stroke. We sought to establish how delirium after stroke is identified, its incidence rates and factors predicting its development. We conducted a systematic review of studies investigating delirium in acute stroke. We searched The Cochrane Collaboration, MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, British Nursing Index, PEDro and OT Seeker in October 2010. A total of 3,127 citations were screened, full text of 60 titles and abstracts were read, of which 20 studies published between 1984 and 2010 were included in this review. The methods most commonly used to identify delirium were generic assessment tools such as the Delirium Rating Scale (n = 5) or the Confusion Assessment Method (n = 2) or both (n = 2). The incidence of delirium in acute stroke ranged from 2.3–66%, with our meta-analysis random effects approach placing the rate at 26% (95% CI 19–33%). Of the 11 studies reporting risk factors for delirium, increased age, aphasia, neglect or dysphagia, visual disturbance and elevated cortisol levels were associated with the development of delirium in at least one study. The outcomes associated with the condition are increased morbidity and mortality. Delirium is found in around 26% of stroke patients. Difference in diagnostic and screening procedures could explain the wide variation in frequency of delirium. There are a number of factors that may predict the development of the condition.
KeywordsDelirium Acute stroke Diagnosis and screening
Ms Carin-Levy is a part time PhD student funded by Queen Margaret University, Edinburgh. No other funding has been received for this study. We are grateful to Prof. Marie Donaghy for her contribution during the development of this project and for her comments on manuscript drafts.
Conflicts of interest
There are no conflicts of interest to disclose.
- 6.Carson A, Zeman A, Brown T, Sharpe M (2004) Organic disorders. In: Johnstone E, Cunningham Owens D, Lawrie S, Sharpe M, Freeman C (eds) Companion to psychiatric studies, 7 ed. edn. Churchill Livingstone, Edinburgh, pp 341–344Google Scholar
- 7.Scottish Intercollegiate Guidelines Network (2010) Management of Patients with Stroke: Rehabilitation, prevention and management of complications, and discharge planning. A National Clinical Guideline. NHS Quality Improvement ScotlandGoogle Scholar
- 8.National Institute for Health and Clinical Excellence (2008) Stroke: National Clinical Guidelines for treatment and initial management of acute stroke and transient ischaemic attack (TIA). London, Royal College of PhysiciansGoogle Scholar
- 9.National Institute for Clinical Excellence (2010) Delirium: Diagnosis prevention and management. NICEGoogle Scholar
- 12.Hatano S (1976) Experience from a Multicentre stroke register: a preliminary report. bulletin of the World Health Organisation; 54 Available at: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366492/. Accessed 15 Sept 2010
- 15.American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders DSM III, 3rd edn. American Psychiatric Association, Washington, DCGoogle Scholar
- 16.American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders: DSM-III-R. American Psychiatric Association, Washington, DCGoogle Scholar
- 17.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM IV. American Psychiatric Association, Washington, DCGoogle Scholar
- 18.American Psychiatric Association (2002) Diagnostic and statistical manual of mental disorders (DSM-IV-R), 4th edn. American Psychiatric Association Press, Washington DCGoogle Scholar
- 19.Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 13:941–948Google Scholar
- 21.Gustafson L, Lindgren M, Westling B (1995) The OBS Scale—a factor analysis approach to evaluation of confusional states and other organic brain syndromes. Unpublished work available from: http://www.med.lu.se. Accessed 1 Jun 2011
- 34.Shih HT, Huang WS, Liu CH, Tsai TC, Lu CT, Lu MK, Chen PK, Tseng CH, Jou SB, Tsai CH, Lee CC (2007) Confusion or delirium in patients with posterior cerebral arterial infarction. Acta Neurol Taiwanica 16:136–142Google Scholar
- 48.Scottish Intercollegiate Guidelines Network (2002) SIGN 64: management of patients with stroke. Rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline. 1–51. Sign, EdinburghGoogle Scholar
- 49.Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710PubMedCrossRefGoogle Scholar