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:
https://doi.org/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
Zdroje
1. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
2. Lin S-M, Liu C-Y, Wang C-H, Lin H-C, Huang C-D, Huang P-Y, et al. The impact of delirium on the survival of mechanically ventilated patients. Critical care medicine. 2004;32(11):2254–9. doi: 10.1097/01.ccm.0000145587.16421.bb 15640638
3. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychology review. 2004;14(2):87–98. 15264710
4. Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, et al. Costs associated with delirium in mechanically ventilated patients. Critical care medicine. 2004;32(4):955–62. doi: 10.1097/01.ccm.0000119429.16055.92 15071384
5. Khan BA, Zawahiri M, Campbell NL, Fox GC, Weinstein EJ, Nazir A, et al. Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research—a systematic evidence review. Journal of hospital medicine. 2012;7(7):580–9. doi: 10.1002/jhm.1949 22684893
6. Lasiter S, Boustani MA. Critical care recovery center: making the case for an innovative collaborative care model for ICU survivors. The American journal of nursing. 2015;115(3):24. doi: 10.1097/01.NAJ.0000461807.42226.3e 25674682
7. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. New England Journal of Medicine. 2013;369(14):1306–16. doi: 10.1056/NEJMoa1301372 24088092
8. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Critical care medicine. 2010;38(7):1513. doi: 10.1097/CCM.0b013e3181e47be1 20473145
9. Patel MB, Bednarik J, Lee P, Shehabi Y, Salluh JI, Slooter AJ, et al. Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review. Critical care medicine. 2018;46(11):1832–41. doi: 10.1097/CCM.0000000000003349 30142098
10. Naidech AM, Beaumont JL, Rosenberg NF, Maas MB, Kosteva AR, Ault ML, et al. Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort. American journal of respiratory and critical care medicine. 2013;188(11):1331–7. doi: 10.1164/rccm.201307-1256OC 24102675
11. Kim DH, Lee J, Kim CA, Huybrechts KF, Bateman BT, Patorno E, et al. Evaluation of algorithms to identify delirium in administrative claims and drug utilization database. Pharmacoepidemiol Drug Saf. 2017;26(8):945–53. doi: 10.1002/pds.4226 28485014; PubMed Central PMCID: PMC5583076.
12. Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The Confusion Assessment Method: a systematic review of current usage. Journal of the American Geriatrics Society. 2008;56(5):823–30. doi: 10.1111/j.1532-5415.2008.01674.x 18384586
13. Lee CC, Ho HC, Su YC, Chen PC, Yu CH, Yang CC. Comparison of different comorbidity measures for oral cancer patients with surgical intervention: A longitudinal study from a single cancer center. Auris Nasus Larynx. 2016;43(3):322–9. doi: 10.1016/j.anl.2015.10.004 26642942.
14. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27. doi: 10.1097/00005650-199801000-00004 9431328.
15. Menendez ME, Ring D, Harris MB, Cha TD. Predicting In-Hospital Mortality in Elderly Patients With Cervical Spine Fractures: A Comparison of the Charlson and Elixhauser Comorbidity Measures. Spine (Phila Pa 1976). 2015;40(11):809–15. doi: 10.1097/BRS.0000000000000892 25785957.
16. McCoy TH Jr, Snapper L, Stern TA, Perlis RH. Underreporting of delirium in statewide claims data: implications for clinical care and predictive modeling. Psychosomatics. 2016;57(5):480–8. doi: 10.1016/j.psym.2016.06.001 27480944
17. Krogseth M, Wyller TB, Engedal K, Juliebø V. Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. Journal of psychosomatic research. 2014;76(1):68–74. doi: 10.1016/j.jpsychores.2013.10.006 24360144
18. Brummel NE, Boehm LM, Girard TD, Pandharipande PP, Jackson JC, Hughes CG, et al. Subsyndromal Delirium and Institutionalization Among Patients With Critical Illness. American Journal of Critical Care. 2017;26(6):447–55. doi: 10.4037/ajcc2017263 29092867
19. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nature Reviews Neurology. 2009;5(4):210. doi: 10.1038/nrneurol.2009.24 19347026
20. Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Critical care clinics. 2017;33(2):225–43. doi: 10.1016/j.ccc.2016.12.005 28284292
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PLOS One
2019 Číslo 11
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