The course of delirium in acute stroke.
OBJECTIVE
several studies have assessed delirium post-stroke but conflicting results have been obtained. Also, the natural history and outcome of delirium post-stroke need to be fully elucidated.


METHODS
eligible stroke patients were assessed for delirium on admission and for four consecutive weeks using the Confusion Assessment Method (CAM). Risk factors for delirium were recorded. Our outcome measures were length of stay, inpatient mortality and discharge destination.


RESULTS
of 110 eligible patients, 82 were recruited over 7 months. Delirium was detected in 23 patients (28%); 21 of these were delirious on their first assessment. Sixty-nine per cent of patients who had four weekly assessments were delirious at 4 weeks. Multivariate logistic regression analysis was performed, and two models were identified. With unsafe swallow in the analysis, delirium was associated with an unsafe swallow on admission (OR 28.4, P<0.001), Barthel score < 10 (OR 32.1, P = 0.004) and poor vision pre-stroke (OR 110.8, P = 0.01). With unsafe swallow removed from the analysis, delirium was associated with an admission C-reactive protein (CRP) > 5 mg/l (OR 10.2, P = 0.009), Barthel score < 10 (OR 46.5, P = 0.001) and poor vision pre-stroke (OR 85.2, P = 0.01). Delirious patients had a higher mortality (30.4% vs. 1.7%, P<0.001), longer length of stay (62.2 vs. 28.9 days, P<0.001) and increased risk of institutionalisation (43.7 vs. 5.2%, OR 14, P<0.001).


CONCLUSIONS
delirium is common post-stroke. Most cases develop at stroke onset and remain delirious for an appreciable period. Delirium onset is associated with stroke severity (low admission Barthel), unsafe swallow on admission, poor vision pre-stroke and a raised admission CRP. Delirium is a marker of poor prognosis.
McManus
John
J
Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. john.mcmanus@kch.nhs.uk
Pathansali
Rohan
R
Hassan
Hardi
H
Ouldred
Emma
E
Cooper
Derek
D
Stewart
Robert
R
Macdonald
Alastair
A
Jackson
Stephen
S
D000465:Algorithms; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000453:epidemiology