Delirium Is Associate with Worse Functional Outcomes and Quality of Life after Intracranial Hemorrhage (S47.002)

Abstract

Objective: To determine how often delirium in Neuro-ICU patients with intracranial hemorrhage can be assessed, its prevalence, and its impact (if any) on functional and quality of life outcomes after discharge. Background Delirium is common in the medical and surgical ICU and is associated with cognitive dysfunction and increased mortality. There are few data in Neuro-ICU patients. Design/Methods: We prospectively identified 87 patients with intracerebral (ICH) or subarachnoid hemorrhage (SAH). Delirium screening was routinely attempted twice daily with the Confusion Assessment Method (CAM), a validated screening tool, and documented in the electronic medical record for later automated retrieval. Delirium was defined as any positive CAM, and no delirium as at least one negative CAM. Patients were prospectively followed up at one and three months with the modified Rankin Scale (mRS), a validated functional scale. Patients with follow-up scheduled in 2011 also had web-based multi-dimensional QOL outcomes assessed with the validated NIH Patient Reported Outcomes Measurement Information System and Neuro-QOL (reported as T scores normalized at 50 ± 10). Results: There were 58 (67%) not delirious, 20 (23%) delirious, and 9 (10%) patients who were never assessable due to coma. In assessable patients, delirium was associated with worse mRS at one month (P=0.008) and three months (P=0.055). In QOL assessment, patients with delirium had lower cognitive QOL, mobility, physical function, satisfaction with social roles and activities (overall -6.1, 95%CI -16.12 to -8.3, P Conclusions: Delirium is common after intracranial hemorrhage and associated with worse functional and QOL outcomes. Future research should clarify the risk factors for delirium in Neuro-ICU patients and determine if they can be modified. Preventing delirium may potentially improve outcomes. Disclosure: Dr. Rosenberg has nothing to disclose. Dr. Cella has received personal compensation for activities with Moffitt Cancer Center Advisory Board as a scientific consultant. Dr. Naidech has received research support from Gaymar Inc.