Table 1.
CASE | DIAGNOSIS | AGE | IQCODE SCOREb | COMORBIDITIES | APACHE-II SCOREc | SOFA SCOREd | CLINICAL REASON FOR IMAGING | LOS SINCE ICU ADMISSION AND DAYS OF DELIRIUM PRIOR TO MRIe | MRI FINDINGS: WMH, ATROPHYf | ORDERS FOLLOWING MRI RESULTS | FINAL REPORTED DELIRIUM DIAGNOSIS | 3-MONTH FOLLOW UPf |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Septic shock | 43 | <3.3 | None | 20 | 13 | Delirium, normal CT scan | 13 days of LOS, 5 days of delirium | Grade 2 No atrophy | Neurology consult, EEG and psychiatry consult | Medical delirium | Ex Func 0.1 |
2 | Acute lung injury | 75 | <3.3 | Diabetes, CAD COPDg | 31 | 15 | Agitation, normal CT | 6 days of LOS, 12 days of delirium | Grade 2 No atrophy | Haloperidol, Olanzapine | Delirium due to hypoxia | Memory 32 Ex Func 0.1 Attention 16 |
3 | ARDS | 35 | <3.3 | None | 31 | 15 | Delirium, normal CT | 9 days of LOS, 3 days of delirium | None No atrophy | Neurology consult, EEG and psychiatry consult | Delirium due to hypoxia | Memory 13 Ex Func 0.1 Attention 1 |
4 | Septic shock | 57 | <3.3 | None | 27 | 14 | Delirium, normal CT | 7 days of LOS, 5 days of delirium | Grade 1 No atrophy | None | Delirium with negative MRI | Memory NA Ex Func 13 Attention 27 |
5 | Acute respiratory failure due to pleural effusion | 65 | <3.3 | Diabetes, HTN, OSA, CHFg | 30 | 10 | AMS, normal CT | 2 days of LOS, 2 days of delirium | Grade 3 No atrophy | Neurology consult, EEG | Delirium due to hypercarbia | Patient died in the hospital |
6 | Septic shock | 52 | <3.3 | HTN, CAD, HIVg | 25 | 13 | AMS, CT (mild atrophy) | 13 days of LOS, 4 days of delirium | Grade 1 No atrophy | None | Medical delirium | Memory 42 Ex Func 13 Attention 27 |
7 | Baclofen overdose | 22 | <3.3 | None | 15 | 11 | AMS, normal CT | 3 days of LOS, 3 days of delirium | No atrophy | Psychiatry consult | Delirium due to baclofen withdrawal | Not available |
8 | Septic shock | 81 | <3.3 | None | 22 | 13 | Delirium, normal CT | 2 days of LOS, 2 days of delirium | Grade 3 No atrophy | Interruption of sedationa | Medical delirium | Memory 53 Ex Func 55 Attention 58 |
The clinical indication to perform an MRI for these patients was delirium. Patients for whom an MRI was ordered for the presence of focal neurological symptoms, ischemia at CT scan, coma, and central nervous system infections were not included in this table. All the patients included in this table were found delirious on the day of the MRI by research staff performing the CAM-ICU evaluation.
The presence of cognitive impairment before hospitalization was determined via the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) at study enrollment. None of the patients included in this table had a baseline cognitive impairment (i.e., IQCODE <3.3).
APACHE-II (Acute Physiology and Chronic Health Evaluation II).
SOFA (Sequential Organ Failure Assessment).
Length of stay (LOS), Intensive Care Unit (ICU).
WMH (white matter hyperintensities) were classified from 0 to 3, based on the number and size of lesions: grade 0 (normal); grade 1 (punctiform), grade 2 (patchy or confluent), and grade 3 (diffuse) according to a previously validated scale.12,13
NPS (Neuropsychological assessment performed at 3-month follow-up): memory (assessed with RBANS delayed call), executive functions (assessed with TRAILS B), attention (assessed with digit symbol).18 The test scores are reported in percentile, adjusted for age, education and race based on normative databases.
CAD (coronary artery disease), COPD (chronic obstructive pulmonary disease), HTN (arterial hypertension), OSA (obstructive sleep apnea), CHF (congestive heart failure), HIV (human immunodeficiency virus).