Predicting delirium in acute ischemic stroke: the PREDELIS score.
Journal of neurology – May 11, 2025
Source: PubMed
Summary
A groundbreaking prediction tool helps doctors identify stroke patients at risk of developing delirium, a serious mental disturbance affecting recovery. By analyzing data from over 14,000 acute ischemic stroke patients, researchers developed a simple scoring system based on key factors like age, previous episodes, and stroke severity. This new prevention tool helps target early interventions where they're needed most.
Abstract
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). 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. 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%). 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.