by Patel, Mayur B.;
Bednarik, Josef; Lee, Patricia; Shehabi, Yahya; Salluh, Jorge I.; Slooter,
Arjen J.; Klein, Kate E.; Skrobik, Yoanna; Morandi, Alessandro; Spronk, Peter
E.; Naidech, Andrew M.; Pun, Brenda T.; Bozza, Fernando A.; Marra, Annachiara;
John, Sayona; Pandharipande, Pratik P.; Ely, E. Wesley
Objectives: The
Society of Critical Care Medicine recommends routine delirium monitoring, based
on data in critically ill patients without primary neurologic injury. We sought
to answer whether there are valid and reliable tools to monitor delirium in
neurocritically ill patients and whether delirium is associated with relevant
clinical outcomes (e.g., survival, length of stay, functional independence,
cognition) in this population.
Data Sources: We
systematically reviewed Cumulative Index to Nursing and Allied Health
Literature, Web of Science, and PubMed. Study Selection and Data Extraction: Inclusion criteria allowed
any study design investigating delirium monitoring in neurocritically ill
patients (e.g., neurotrauma, ischemic, and/or hemorrhagic stroke) of any age.
We extracted data relevant to delirium tool sensitivity, specificity, negative
predictive value, positive predictive value, interrater reliability, and
associated clinical outcomes.
Data Synthesis: Among
seven prospective cohort studies and a total of 1,173 patients, delirium was
assessed in neurocritically patients using validated delirium tools after
considering primary neurologic diagnoses and associated complications, finding
a pooled prevalence rate of 12–43%. When able to compare against a common
reference standard, Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, the test characteristics showed a sensitivity of 62–76%,
specificity of 74–98%, positive predictive value of 63–91%, negative predictive
value of 70–94%, and reliability kappa of 0.64–0.94. Among four studies
reporting multivariable analyses, delirium in neurocritically patients was
associated with increased hospital length of stay (n = 3) and ICU length of
stay (n = 1), as well as worse functional independence (n = 1) and cognition (n
= 2), but not survival.
Conclusions: These
data from studies of neurocritically ill patients demonstrate that patients
with primary neurologic diagnoses can meet diagnostic criteria for delirium and
that delirious features may predict relevant untoward clinical outcomes. There
is a need for ongoing investigations regarding delirium in these complicated
neurocritically ill patients.
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