In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium


Autoři: Farhaan S. Vahidy aff001;  Arvind B. Bambhroliya aff001;  Jennifer R. Meeks aff001;  Omar Rahman aff002;  E. Wesley Ely aff003;  Arjen J. C. Slooter aff005;  Jon E. Tyson aff006;  Charles C. Miller aff006;  Louise D. McCullough aff001;  Sean I. Savitz aff001;  Babar Khan aff002
Působiště autorů: The Institute of Stroke and Cerebrovascular Diseases and The Department of Neurology, McGovern Medical School at University of Texas Health Science Center, Houston, Texas, United States of America aff001;  Division of Pulmonary/Critical Care, Indiana University School of Medicine, Indianapolis, Indiana, United States of America aff002;  Critical Illness, Brain Dysfunction, Survivorship (CIBS) Center, Vanderbilt University Medical Center, Department of Medicine, Nashville, Tennessee, United States of America aff003;  Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN, United States of America aff004;  Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands aff005;  Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, United States of America aff006;  Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indiana University Center for Health Innovation and Implementation Science; Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana, United States of America aff007
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225204

Souhrn

Objective

Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients.

Methods

We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95% confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes.

Results

We identified 3,107,437 stroke discharges of whom 7.45% were coded to have delirium. This proportion significantly increased between 2010 (6.3%) and 2015 (8.7%) (aOR, 95% CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0%, SAH: 9.8%) as compared to IS patients (7.0%). Delirious stroke patients had higher in-hospital mortality (12.3% vs. 7.8%), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7%) as compared to those without delirium (12.2%) (aRR, 95% CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3% vs. 6.4%).

Conclusion

Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.

Klíčová slova:

Cognitive impairment – Health care facilities – Hemorrhagic stroke – Hospitals – Intensive care units – Ischemic stroke – stroke – Neurological drug therapy


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Článek vyšel v časopise

PLOS One


2019 Číslo 11