Nursing Science and development, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany.
Christian Albrechts University Kiel, Kiel, Germany.
J Neurol. 2022 Jul;269(7):3735-3744. doi: 10.1007/s00415-022-11000-6. Epub 2022 Feb 14.
Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management.
Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others.
Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6-4.7) vs. post 3.0 (2.2-4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved.
Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke.
DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436 .
卒中单元（SU）中的卒中后谵妄（POD）与并发症风险增加和临床结局较差相关。目的是通过实施跨专业谵妄管理来降低 POD 的严重程度。
在五个 SU 上进行多中心质量改进项目，实施谵妄管理，进行前后比较。主要结局是使用护理谵妄筛查量表（Nu-DESC）评估的 POD 严重程度。次要结局参数包括 POD 发生率、持续时间、改良 Rankin 量表（mRS）、SU 和医院的住院时间、死亡率和其他参数。
共纳入 799 例患者，其中 59.4%（n=475）可纳入研究，9.5%（n=45）发生谵妄。实施谵妄管理后，POD 严重程度降低；Nu-DESC 中位数：前：3.5（2.6-4.7）vs. 后：3.0（2.2-4.0），但无统计学意义（p=0.154）。其他结局参数无显著差异。在后一阶段，75%（n=18）的谵妄患者可以接受谵妄管理，只有 24 例（53.3%）的谵妄患者需要药物治疗。与类似的非谵妄患者相比，病情更严重的卒中患者和 POD 患者仍处于残疾水平，而这些患者的病情有所改善。
在 SU 上实施谵妄管理是可行的，可以提供给大多数患者，但效果有限。护理干预作为首选可提供给大多数患者，只有一半的患者需要药物治疗。谵妄管理可能会降低 POD 的严重程度，但对 POD 的持续时间或住院时间只有部分影响。POD 会阻碍康复，尤其是在病情更严重的卒中患者中。
DRKS，DRKS00021436。注册于 2020 年 4 月 17 日，www.drks.de/DRKS00021436。
