Fluctuations of consciousness after stroke: Associations with the confusion assessment method for the intensive care unit (CAM-ICU) and potential undetected delirium

Research output: Contribution to journalArticle

Authors

  • Michael E. Reznik
  • Lori A. Daiello
  • Bradford B. Thompson
  • Linda C. Wendell
  • Ali Mahta
  • N. Stevenson Potter
  • Shadi Yaghi
  • Mitchell M. Levy
  • Corey R. Fehnel
  • Karen L. Furie
  • Richard N. Jones

External Institution(s)

  • Brown University
  • Harvard University

Details

Original languageEnglish (US)
Pages (from-to)58-62
Number of pages5
JournalJournal of Critical Care
Volume56
StatusPublished - Apr 2020
Peer-reviewedYes

Abstract

Purpose: To examine associations between fluctuating consciousness and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessments in stroke patients compared to non-neurological patients. Materials and methods: We linked all recorded CAM-ICU assessments with corresponding Richmond Agitation Sedation Scale (RASS) measurements in patients with stroke or sepsis from a single-center ICU database. Fluctuating consciousness was defined by RASS variability using standard deviations (SD) over 24-h periods; regression analyses were performed to determine associations with RASS variability and CAM-ICU rating. Results: We identified 16,509 paired daily summaries of CAM-ICU and RASS measurements in 546 stroke patients and 1586 sepsis patients. Stroke patients had higher odds of positive (OR 4.2, 95% CI 3.3–5.5) and “unable to assess” (UTA; OR 5.2, 95% CI 4.0–6.8) CAM-ICU ratings compared to sepsis patients, and CAM-ICU-positive and UTA assessment-days had higher RASS variability than CAM-ICU-negative assessment-days, especially in stroke patients. Based on model-implied associations of RASS variability (OR 2.0 per semi-IQR-difference in RASS-SD, 95% CI 1.7–2.2) and stroke diagnosis (OR 2.7, 95% CI 2.0–3.7) with CAM-ICU-positive assessments, over one-third of probable delirium cases among stroke patients were potentially missed by the CAM-ICU. Conclusions: Post-stroke delirium may frequently go undetected by the CAM-ICU, even in the setting of fluctuating consciousness.

    Research areas

  • Consciousness, Delirium, Sepsis, Stroke

Citation formats

APA

Reznik, M. E., Daiello, L. A., Thompson, B. B., Wendell, L. C., Mahta, A., Potter, N. S., ... Jones, R. N. (2020). Fluctuations of consciousness after stroke: Associations with the confusion assessment method for the intensive care unit (CAM-ICU) and potential undetected delirium. Journal of Critical Care, 56, 58-62. https://doi.org/10.1016/j.jcrc.2019.12.008

Harvard

Reznik, ME, Daiello, LA, Thompson, BB, Wendell, LC, Mahta, A, Potter, NS, Yaghi, S, Levy, MM, Fehnel, CR, Furie, KL & Jones, RN 2020, 'Fluctuations of consciousness after stroke: Associations with the confusion assessment method for the intensive care unit (CAM-ICU) and potential undetected delirium', Journal of Critical Care, vol. 56, pp. 58-62. https://doi.org/10.1016/j.jcrc.2019.12.008