Predicting delirium in acute ischemic stroke: the PREDELIS score.

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.