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. 2025 May 11;272(6):391.
doi: 10.1007/s00415-025-13073-5.

Predicting delirium in acute ischemic stroke: the PREDELIS score

Natalie Berger  1 , Diether Kramer  2 , Michael Schrempf  3 , Edith Hofer  1   4 , Alexander Pichler  1 , Simon Fandler-Höfler  1 , Melanie Haidegger  1 , Isra Hatab  1 , Martin Heine  5 , Jan Jagiello  6 , Herbert Koller  7 , Stefan Lilek  8 , Sai Veeranki  2 , Christian Enzinger  1 , Thomas Gattringer  1 , Markus Kneihsl  9   10
Affiliations

Predicting delirium in acute ischemic stroke: the PREDELIS score

Natalie Berger et al. J Neurol. .

Abstract

Background: Delirium, defined as an acute, fluctuating disturbance in consciousness, attention and cognition, is a common stroke complication and associated with poor functional outcome. Although resource-intensive prevention strategies could reduce delirium rates, their implementation in unselected stroke patients is challenging. This study aimed to develop a risk score for predicting delirium in acute ischemic stroke (PREDELIS).

Methods: We retrospectively included all ischemic stroke patients admitted to five stroke units of Styria, Austria, between 2013 and 2021. Data were retrieved from a comprehensive medical information system using semi-automated data extraction. The PREDELIS score was based on multivariable logistic regression analysis to identify admission variables associated with delirium.

Results: 14,475 acute ischemic stroke patients (median age: 76 years, 46% women) were split in a 40% derivation (n = 6151; delirium = 398, 6.5%) and a 60% validation cohort (n = 8324; delirium: 568, 6.8%). Previous delirium (4 points), chronic alcohol consumption (3), age > 70 years (2), male sex (2), infection (2), admission NIHSS > 7 (1), non-lacunar stroke (1) and vision/hearing impairment (1) were associated with delirium (all p < 0.05) and included in our score (median: 5 points). The score´s area under the curve was 0.72 in both the derivation (95% CI 0.69-0.75) and the validation cohort (95% CI 0.70-0.74). While patients with a score of ≤ 5 had a low delirium risk (2.5%), a score of ≥ 9 indicated a high risk (30.9%).

Discussion and conclusion: This study introduces a novel score for early delirium risk estimation in ischemic stroke patients, aiding clinicians in identifying high-risk individuals for targeted screening and prevention.

Keywords: Acute ischemic stroke; Delirium; Prediction score; Prevention.

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Conflict of interest statement

Declarations. Conflicts of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest. The authors have nothing to disclose relating to the subject matter of this article. Informed consent and ethical approval: This study has been approved by the local ethics committee and has therefore been performed in accordance with the ethical standards. Based on the retrospective study design, informed consent was waived by the ethics committee.

Figures

Fig. 1
Fig. 1
Delirium risk according to the PREDELIS score, the Delirium Risk Assessment Score (DRAS) and Oldenbeuving et al. (Model 1 and Model 2)
Fig. 2
Fig. 2
Comparison of the receiver operating characteristics curves of different scores for estimating delirium risk in acute stroke patients
See this image and copyright information in PMC

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