Table 4.

Delirium Associations with Outcomes: Qualitative Results from a Systematic Review of Delirium Monitoring in the Neurocritically Ill

Ref	Death	ICU LOS	Hospital LOS	Disposition and Neuropsychological Outcomes
(46)	Unchanged 6-month mortality (HR=1.22; 95%CI: 0.48–2.98; P=0.668)a	-	Increased length of hospital stay (HR=1.63; 95% CI: 1.11–2.38; P=0.013)b	-
(47)	-	Longer ICU LOS (mean 2.1d longer; 95%CI: 1.1–4.5; P=0.03)c	Longer hospital LOS (mean 3.5d longer; 95%CI: 1.5–8.3; P=0.004)d	Poor mRS at 28d (OR=8.7, 95%CI: 1.4–52.5; P=0.018)e Worse HRQoL (domains of applied cognition–executive function and fatigue)f
(48)	Unchanged in-hospital mortality (OR=2.0; 95%CI: 0.8–5.1, P<0.001)g	-	Longer hospital LOS by 5.4d (95% CI: 2.1–8.6, P<0.001)h	Worse 1 mo. BI (median BI 20.0 vs. 7.5, P<0.001)i Unfavorable outcome (OR=2.0; 95%CI 1.0–4.0, P<0.001)j
(49)	-	-	-	Worse cognitive function HRQoL at 28d and 1yk

BI, Barthel Index; d, Days; HRQoL, Health-related Quality of Life using Neuro-QOL (Quality of Life in Neurological Disorders) metric; ICU, Intensive Care Unit; IQR, Interquartile range; LOS, Length of Stay; mo., Months; mRS, modified Rankin Scale; Ref, Reference; vs., Versus

^aMultivariable cox regression model shown in table was adjusted for age, gender, prestroke dementia, National Institutes of Health Stroke Scale at admission, first-day Sequential Organ Failure Assessment, and aphasia; Univariate data showed 6-month mortality with Delirium: 23.6% vs. No Delirium: 14.9%

^bMultivariable cox regression model using time-dependent covariate analysis was adjusted for age, gender, prestroke dementia, National Institutes of Health Stroke Scale at admission, first-day Sequential Organ Failure Assessment, and aphasia; Univariate data showed Hospital Length of Stay with Delirium:18.0d vs. No Delirium:12.0d

^cMultivariable data shown in table was adjusted for age, admit National Institutes of Health Stroke Scale, and any benzodiazepine exposure; Univariate data showed ICU Length of Stay with Delirium: 7.0d (IQR: 3.4–10.2) vs. No Delirium: 2.3d (IQR: 1.1–6.7)

^dMultivariable data shown in table was adjusted for age, admit National Institutes of Health Stroke Scale, and any benzodiazepine exposure; Univariate data showed hospital Length of Stay with Delirium: 13.2d (IQR:7.9–24.2) vs. No Delirium: 6.4d(IQR:4.0–13.2)

^eMultivariable data shown in table demonstrated an increased odds of poor outcome at 28 days of mRS>3 vs. mRS<2, and was adjusted for admission National Institutes of Health Stroke Scale and age

^fMultivariable data shown in table was adjusted for the National Institutes of Health Stroke Scale, age, benzodiazepine exposure, and time to follow-up

^gMultivariable data shown in table was adjusted for age, IQCODE score, and severity of stroke (NIHSS score); Univariate data showed in-hospital mortality for Delirium: 19.4% vs. No Delirium: 6.5%

^hMultivariable data shown in table was adjusted for age, Informant Questionnaire on Cognitive Decline in the Elderly score, and stroke severity; Univariate showed showed a longer hospital stay with Delirium:23.7d vs. No Delirium:13.9d

ⁱUnivariate analysis only

^jMultivariable data shown in table defined unfavorable outcome at 1 month as dead or BI <12 (BI range 0 –20) for those with delirium, and the OR was corrected for age, National Institutes of Health Stroke Scale, and Informant Questionnaire on Cognitive Decline in the Elderly score; Univariate data showed unfavorable outcome with Delirium:66.7% vs. No Delirium:21.3%

^kMultivariable summary shown in table that controlled for age, National Institutes of Health Stroke Scale, time of assessment, and multiple comparisons; 28d NeuroQOL T-scores for delirium with agitation 20.9±7.3, delirium without agitation 30.4±16.5, agitation without delirium 36.6±17.5, and neither agitated nor delirious 40.3±15.9; P=0.03) and at 1 year (P=0.006); agitation defined as Richmond Agitation-Sedation Scale score>=2