Article
Incidence and Risk factors for Delirium in patients with aneurysmal Subarachnoid Hemorrhage
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Published: | June 9, 2017 |
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Objective: Delirium is a known comorbidity in intensive care patients and especially in patients with neurological diseases such as aneurysmal subarachnoid hemorrhage (SAH). Nevertheless, data on delirium after SAH are rare. The aim of this study was to evaluate the rate of delirium in a cohort of SAH patients and to identify predisposing factors for delirium.
Methods: Patients with SAH treated between 01/2012 and 07/2016 in a single center were retrospectively analyzed using the Richmond Agitation and Sedation Scale (RASS), a highly validated numerative scale representing the gold standard for scoring of delirium in intensive care medicine. The RASS ranges from -5 (unarousable) to +4 (combative) and is recorded at least every 8 hours or in case of an unexpected event. Delirium was defined as a RASS ≥ 2. Only patients who reached a RASS of 0 (calm and alert) at least once during the clinical course were included in the analysis for predictive factors. In these patients we performed a univariate regression-, followed by a multivariate analysis. The level of significance was set to 0.05.
Results: In the given period 213 patients had a complete documentation of the RASS. The rate of delirium was 31.0% (n=66/213) for the whole cohort and 35.1% in patients reaching a calm and alert consciousness (RASS of 0). In the univariate analysis, male gender (p=0.023), lower Glasgow Coma Scale at admission (p=0.001), higher Hunt & Hess grade (p=0.003), higher Fisher grade (p=0.025), presence of initial hydrocephalus (p=0.008), intraventricular blood volume measured by Le Roux score (p=0.003), initial signs of herniation (p=0.039), higher Simplified Acute Physiology Scale (p=0.01), microsurgical clipping of the aneurysm (p=0.034) and cerebral infarctions on cranial computer tomography (p=0.017) were associated with a higher rate of delirium. Male gender (p=0.018), microsurgical clipping of the aneurysm (p=0.001) and presence of an initial hydrocephalus (p=0.002) were independent predictors for the occurrence of a delirium in the multivariate analysis. Medical treatment of delirium was necessary in 87.9% of patients (n=58/66).
Conclusion: Delirium is a frequent comorbidity in patients suffering from SAH with a rate of up to 35% and seems to be especially associated with male gender, microsurgical clipping and presence of an initial hydrocephalus.