Predicting delirium in acute ischemic stroke: the PREDELIS score.
Natalie Berger, Diether Kramer, Michael Schrempf, Edith Hofer, Alexander Pichler, Simon Fandler-Höfler, Melanie Haidegger, Isra Hatab, Martin Heine, Jan Jagiello, Herbert Koller, Stefan Lilek, Sai Veeranki, Christian Enzinger, Thomas Gattringer, Markus Kneihsl
Journal of neurology May 11, 2025 DOI: 10.1007/s00415-025-13073-5 via PubMed
Summary
AI-generated from the abstractDelirium is a common complication of acute ischemic stroke and is linked to poor outcomes. A new risk score, PREDELIS, was developed using data from 14,475 stroke patients admitted to five Austrian stroke units between 2013 and 2021. Eight factors available at hospital admission predicted delirium: previous delirium, chronic alcohol use, age over 70, male sex, infection, high stroke severity, non-lacunar stroke type, and vision or hearing impairment. The score achieved moderate predictive accuracy, with patients scoring 5 or fewer points having a 2.5% risk of delirium, while those scoring 9 or more had a 30.9% risk. The tool can help clinicians identify high-risk patients for targeted prevention.
Study at a glance
| Characteristics | Retrospective cohort study Peer reviewed |
|---|---|
| Sample size | 14,475 |
| Population | Acute ischemic stroke patients admitted to five stroke units in Styria, Austria |
| Keywords | Acute ischemic stroke Prediction score Stroke care Delirium prevention Medical prediction tools |
| Citations | 4 |
| Key finding | The PREDELIS score, based on eight admission variables, predicted delirium in acute ischemic stroke patients with moderate accuracy, distinguishing low-risk (2.5%) from high-risk (30.9%) groups. |
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.