From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland.
Stroke. 2019 Nov;50(11):3028-3036. doi: 10.1161/STROKEAHA.119.025015. Epub 2019 Sep 26.
Background and Purpose- Delirium is associated with increased mortality, length of stay, and poor functional outcome following critical illness. The epidemiology of delirium in stroke is poorly described. We sought to collate evidence around occurrence (incidence or prevalence) of delirium in acute stroke. Methods- We searched multiple cross-disciplinary electronic databases using a prespecified search strategy, complemented by hand searching. Eligible studies described delirium in acute (first 6 weeks) stroke. We compared delirium occurrence using random-effects models to describe summary estimates. We assessed risk of bias using the Newcastle-Ottawa tool, incorporating this in sensitivity analyses. We performed subgroup analyses for delirium diagnostic method (confusion assessment method scoring, clinical diagnosis, other), duration and timing of delirium assessment (>1 or <1 week), and performed meta-regression based on the year of publication. Results- Of 8822 titles, we included 32 papers (6718 participants) in the quantitative analysis. Summary estimate for occurrence of delirium was 25% (95% CI, 20%-30%; moderate quality evidence). Limiting to studies at low risk of bias (22 studies, 4422 participants), the occurrence rate was 23% (95% CI, 17%-28%). Subgroup summary estimates suggest that delirium occurrence may vary with assessment method: confusion assessment method, 21% (95% CI, 16%-27%); clinical diagnosis, 27% (95% CI, 19%-38%); other, 32% (95% CI, 22%-43%) but not with duration and timing of assessment. Meta-regression suggested decline in occurrence of delirium comparing historical to more recent studies (slope, 0.03 [SE, 0.004]; <0.0001). Conclusions- Delirium is common, affecting 1 in 4 acute stroke patients. Reported rates of delirium may be dependent on assessment method. Our estimate of delirium occurrence could be used for audit, to plan intervention studies, and inform clinical practice. Clinical Trial Registration- URL: http://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42015029251.
背景与目的- 谵妄与危重病患者的死亡率、住院时间延长和功能预后不良有关。中风后谵妄的流行病学描述得很差。我们试图收集有关急性中风中谵妄发生（发病率或患病率）的证据。
方法- 我们使用预先指定的搜索策略在多个跨学科电子数据库中进行搜索，并辅以手动搜索。符合条件的研究描述了急性（前 6 周）中风中的谵妄。我们使用随机效应模型比较了谵妄的发生情况，以描述汇总估计值。我们使用纽卡斯尔-渥太华工具评估偏倚风险，并将其纳入敏感性分析。我们对谵妄诊断方法（意识模糊评估方法评分、临床诊断、其他）、谵妄评估的持续时间和时间（>1 周或<1 周）进行了亚组分析，并根据发表年份进行了元回归分析。
结果- 在 8822 个标题中，我们对 32 篇论文（6718 名参与者）进行了定量分析。谵妄发生率的汇总估计值为 25%（95%CI，20%-30%；中等质量证据）。限制在低偏倚风险的研究（22 项研究，4422 名参与者）中，发生率为 23%（95%CI，17%-28%）。亚组汇总估计值表明，谵妄的发生可能因评估方法而异：意识模糊评估方法，21%（95%CI，16%-27%）；临床诊断，27%（95%CI，19%-38%）；其他，32%（95%CI，22%-43%），但与评估的持续时间和时间无关。元回归表明，与历史研究相比，较新的研究中谵妄的发生率下降（斜率，0.03[SE，0.004]；<0.0001）。
结论- 谵妄很常见，影响了 1/4 的急性中风患者。报告的谵妄发生率可能取决于评估方法。我们对谵妄发生率的估计可用于审计、计划干预研究和指导临床实践。
临床试验注册- URL：http://www.crd.york.ac.uk/PROSPERO/。唯一标识符：CRD42015029251。
