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. 2013 Dec 1;188(11):1331-7.
doi: 10.1164/rccm.201307-1256OC.

Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort

Andrew M Naidech  1 , Jennifer L Beaumont, Neil F Rosenberg, Matthew B Maas, Adam R Kosteva, Michael L Ault, David Cella, E Wesley Ely
Affiliations

Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort

Andrew M Naidech et al. Am J Respir Crit Care Med. .

Abstract

Rationale: The prognostic significance of delirium symptoms in intensive care unit (ICU) patients with focal neurologic injury is unclear.

Objectives: To determine the relationship between delirium symptoms and subsequent functional outcomes and quality of life (QOL) after intracerebral hemorrhage.

Methods: We prospectively enrolled 114 patients. Delirium symptoms were routinely assessed twice daily using the Confusion Assessment Method for the ICU by trained nurses. Functional outcomes were recorded with modified Rankin Scale (scored from 0 [no symptoms] to 6 [dead]), and QOL outcomes with Neuro-QOL at 28 days, 3 months, and 12 months.

Measurements and main results: Thirty-one (27%) patients had delirium symptoms ("ever delirious"), 67 (59%) were never delirious, and the remainder (14%) had persistent coma. Delirium symptoms were nearly always hypoactive, were detected mean 6 days after intracerebral hemorrhage presentation, and were associated with longer ICU length of stay (mean 3.5 d longer in ever vs. never delirious patients; 95% confidence interval, 1.5-8.3; P = 0.004) after correction for age, admit National Institutes of Health (NIH) Stroke Scale, and any benzodiazepine exposure. Delirium symptoms were associated with increased odds of poor outcome at 28 days (odds ratio, 8.7; 95% confidence interval, 1.4-52.5; P = 0.018) after correction for admission NIH Stroke Scale and age, and with worse QOL in the domains of applied cognition-executive function and fatigue after correcting for the NIH Stroke Scale, age, benzodiazepine exposure, and time of follow-up.

Conclusions: After focal neurologic injury, delirium symptoms were common despite low rates of infection and sedation exposure, and were predictive of subsequent worse functional outcomes and lower QOL.

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Figures

<i>Figure 1.</i>
Figure 1.
Unadjusted Kaplan-Meier plot of length of stay in the intensive care unit (ICU). Lines are stratified by patients who had no delirium symptoms (ND, solid line) or who had delirium symptoms (DS, stippled line). In Kaplan-Meier analysis, delirium symptoms were associated with median ICU length of stay of 7.0 (1.5–12.6) versus 2.4 (1.4–3.4) days (P = 0.02 by log-rank test).
<i>Figure 2.</i>
Figure 2.
Domain-specific quality of life (QOL) scores at 28 days, stratified by delirium. Patients with delirium had poorer mean QOL in all domains. T scores from Neuro-QOL are presented as SD below the mean compared with the U.S. general population for ease of viewing. In mixed models accounting all time-points of follow-up (Table 3), delirium symptoms were associated with lower QOL in the domains of applied cognition–executive function and fatigue.
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References

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