Delirium prevalence, risk factors and outcomes among patients with acute stroke: A multi-centre observational study

IF 1.1 Q3 NURSING
Irene Mansutti , Luisa Saiani , Daniela Cargnelutti , Stefania Petrucco , Viera Giannina , Cristina Di Domenico , Paolo Passadore , Alvisa Palese
{"title":"Delirium prevalence, risk factors and outcomes among patients with acute stroke: A multi-centre observational study","authors":"Irene Mansutti ,&nbsp;Luisa Saiani ,&nbsp;Daniela Cargnelutti ,&nbsp;Stefania Petrucco ,&nbsp;Viera Giannina ,&nbsp;Cristina Di Domenico ,&nbsp;Paolo Passadore ,&nbsp;Alvisa Palese","doi":"10.1016/j.jvn.2022.09.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Delirium is a frequent and serious acute neuropsychiatric syndrome leading to worse prognosis including mortality. Patients with ischaemic and/or haemorrhagic stroke are vulnerable to delirium. However, predisposing and precipitating factors have not been fully discovered to date, leaving this area of practice under-represented in available guidelines.</p></div><div><h3>Aims</h3><p>To describe the prevalence, associated factors and main in-hospital outcomes of post-stroke delirium.</p></div><div><h3>Methods</h3><p>A multi-centre observational study was conducted from 2019 to 2020 and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were collected in stroke units located in two large hospitals in the North-East region of Italy. Consecutive adult patients with ischaemic and/or haemorrhagic stroke with a Glasgow Coma Scale &gt; 5, who were willing to participate, were included. Data at admission, during the in-hospital stay and at discharge were collected by trained nurses, not involved in the care of patients, with (a) validated tools, (b) direct observation, and (c) access of patients’ records.</p></div><div><h3>Results</h3><p>A total of 78 patients were enrolled (mean 73.1 years; 59% male), and 70.5% of them had suffered an ischaemic stroke. The mean National Institutes of Health Stroke Scale (NIHSS) at admission was 8.2 ± 7.0. A total of 34.6% of patients developed post-stroke delirium; the onset was mainly on the first day of admission (70.4%) and the condition lasted for an average of 3.7 days (SD 2.6). In the multivariate logistic regression, 64.1% of the delirium variance was explained by the NIHSS scores (RR 1.259, 95%CI 1.035–1.533; <em>p</em> = 0.022). Patients with post-stroke delirium reported higher functional dependence at discharge and the need for more delaying of hospital care to be admitted in rehabilitation units.</p></div><div><h3>Conclusions</h3><p>At admission, higher scores in the NIHSS evaluation might suggest which patients are at an increased risk of delirium. Avoiding interventions that could potentially increase this risk, together with continuous surveillance, become imperative for nurses who are constantly and closely present by their patients’ side, in order to prevent this serious complication.</p></div>","PeriodicalId":45419,"journal":{"name":"Journal of Vascular Nursing","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular Nursing","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1062030322000486","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 1

Abstract

Background

Delirium is a frequent and serious acute neuropsychiatric syndrome leading to worse prognosis including mortality. Patients with ischaemic and/or haemorrhagic stroke are vulnerable to delirium. However, predisposing and precipitating factors have not been fully discovered to date, leaving this area of practice under-represented in available guidelines.

Aims

To describe the prevalence, associated factors and main in-hospital outcomes of post-stroke delirium.

Methods

A multi-centre observational study was conducted from 2019 to 2020 and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were collected in stroke units located in two large hospitals in the North-East region of Italy. Consecutive adult patients with ischaemic and/or haemorrhagic stroke with a Glasgow Coma Scale > 5, who were willing to participate, were included. Data at admission, during the in-hospital stay and at discharge were collected by trained nurses, not involved in the care of patients, with (a) validated tools, (b) direct observation, and (c) access of patients’ records.

Results

A total of 78 patients were enrolled (mean 73.1 years; 59% male), and 70.5% of them had suffered an ischaemic stroke. The mean National Institutes of Health Stroke Scale (NIHSS) at admission was 8.2 ± 7.0. A total of 34.6% of patients developed post-stroke delirium; the onset was mainly on the first day of admission (70.4%) and the condition lasted for an average of 3.7 days (SD 2.6). In the multivariate logistic regression, 64.1% of the delirium variance was explained by the NIHSS scores (RR 1.259, 95%CI 1.035–1.533; p = 0.022). Patients with post-stroke delirium reported higher functional dependence at discharge and the need for more delaying of hospital care to be admitted in rehabilitation units.

Conclusions

At admission, higher scores in the NIHSS evaluation might suggest which patients are at an increased risk of delirium. Avoiding interventions that could potentially increase this risk, together with continuous surveillance, become imperative for nurses who are constantly and closely present by their patients’ side, in order to prevent this serious complication.

急性脑卒中患者谵妄患病率、危险因素和结局:一项多中心观察性研究
背景:谵妄是一种常见且严重的急性神经精神综合征,预后较差,包括死亡。缺血性和/或出血性中风患者易出现谵妄。然而,迄今为止,尚未充分发现诱发和促成因素,使这一实践领域在现有指南中代表性不足。目的了解脑卒中后谵妄的患病率、相关因素及主要住院结果。方法2019 - 2020年开展一项多中心观察性研究,按照《加强流行病学观察性研究报告指南》进行报告。数据收集于位于意大利东北部地区两家大型医院的中风科室。伴有格拉斯哥昏迷评分的缺血性和/或出血性中风的连续成年患者;5名愿意参加的人被纳入。入院时、住院期间和出院时的数据由训练有素的护士收集,这些护士不参与患者的护理,使用(a)经过验证的工具,(b)直接观察,(c)查阅患者记录。结果共纳入78例患者,平均年龄73.1岁;(59%为男性),其中70.5%曾患过缺血性中风。入院时美国国立卫生研究院卒中量表(NIHSS)平均为8.2±7.0。34.6%的患者出现脑卒中后谵妄;发病以入院第1天为主(70.4%),病程平均为3.7 d (SD 2.6)。在多因素logistic回归中,64.1%的谵妄方差可由NIHSS评分解释(RR 1.259, 95%CI 1.035-1.533;p = 0.022)。卒中后谵妄患者出院时的功能依赖性较高,需要更多的延迟住院治疗才能入住康复病房。结论入院时,NIHSS评分越高,谵妄发生风险越高。避免可能增加这种风险的干预措施,以及持续监测,对于经常密切陪伴在患者身边的护士来说,是必要的,以防止这种严重的并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
1.40
自引率
0.00%
发文量
33
期刊介绍: Journal of Vascular Nursing provides clinical information regarding aortic and peripheral aneurysms, upper and lower extremity arterial disease, acute and chronic venous disease, and more. Original, peer-reviewed articles present descriptions, etiologies, diagnostic procedures, medical and surgical treatment and nursing implications of vascular system disorders.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信