Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

Gail Carin-Levy,Frederike Van Wijck,Gillian E Mead,Kath Nicol

doi:10.1155/2013/620186

Abstract

Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.

Highlights

Delirium is a common neuropsychiatric condition affecting 20–30% of elderly patients across most hospital settings [1]
The most recent guidance published in the United Kingdom (UK) by both the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Physicians (RCP) do not mention delirium as a specific complication of stroke [15, 16]; both refer to cognitive impairment and inattention
Clinical guidelines from other English speaking countries were examined for comparison: Australian guidelines [18] do not mention delirium in stroke patients; American Heart Association (AHA) guidelines mention delirium in the context of screening for psychiatric sequelae to stroke in the end of life care [19]; Canadian

Summary

Introduction

Delirium is a common neuropsychiatric condition affecting 20–30% of elderly patients across most hospital settings [1]. Recent studies have clearly demonstrated that patients who develop delirium are more likely to die within 12 months, have poorer functional outcomes, and are at higher risk of developing dementia [4, 5, 11, 12]. The most recent guidance published in the United Kingdom (UK) by both the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Physicians (RCP) do not mention delirium as a specific complication of stroke [15, 16]; both refer to cognitive impairment and inattention. Clinical guidelines from other English speaking countries were examined for comparison: Australian guidelines [18] do not mention delirium in stroke patients; American Heart Association (AHA) guidelines mention delirium in the context of screening for psychiatric sequelae to stroke in the end of life care [19]; Canadian

Methods

Results

Conclusion