Delirium monitoring in neurocritically ill patients: A systematic review

Mayur B. Patel, Josef Bednarik, Patricia Lee, Yahya Shehabi, Jorge I. Salluh, Arjen J. Slooter, Kate E. Klein, Yoanna Skrobik, Alessandro Morandi, Peter E. Spronk, Andrew M. Naidech, Brenda T. Pun, Fernando A. Bozza, Annachiara Marra, Sayona John, Pratik P. Pandharipande, E. Wesley Ely*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

Abstract

Objectives: The Society of Critical Care Medicine recommends routine delirium monitoring, based on data in critically ill patients without primary neurologic injury. We sought to answer whether there are valid and reliable tools to monitor delirium in neurocritically ill patients and whether delirium is associated with relevant clinical outcomes (e.g., survival, length of stay, functional independence, cognition) in this population. Data Sources: We systematically reviewed Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed. Study Selection and Data Extraction: Inclusion criteria allowed any study design investigating delirium monitoring in neurocritically ill patients (e.g., neurotrauma, ischemic, and/or hemorrhagic stroke) of any age. We extracted data relevant to delirium tool sensitivity, specifcity, negative predictive value, positive predictive value, interrater reliability, and associated clinical outcomes. Data Synthesis: Among seven prospective cohort studies and a total of 1,173 patients, delirium was assessed in neurocritically patients using validated delirium tools after considering primary neurologic diagnoses and associated complications, fnding a pooled prevalence rate of 12-43%. When able to compare against a common reference standard, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the test characteristics showed a sensitivity of 62-76%, specifcity of 74-98%, positive predictive value of 63-91%, negative predictive value of 70-94%, and reliability kappa of 0.64-0.94. Among four studies reporting multivariable analyses, delirium in neurocritically patients was associated with increased hospital length of stay (n = 3) and ICU length of stay (n = 1), as well as worse functional independence (n = 1) and cognition (n = 2), but not survival.

Original languageEnglish (US)
Pages (from-to)1832-1841
Number of pages10
JournalCritical care medicine
Volume46
Issue number11
DOIs
StatePublished - 2018

Keywords

  • Delirium
  • Intensive care unit
  • Neurocritical care
  • Neurotrauma
  • Stroke
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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