Department of Neurology, Massachusetts General Hospital, USA; Department of Neurology, Mount Sinai Medical Center, India.
Department of Neurology, Massachusetts General Hospital, USA; Lawrence Center for Quality and Safety, Massachusetts General Hospital, USA.
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107249. doi: 10.1016/j.jstrokecerebrovasdis.2023.107249. Epub 2023 Aug 1.
Patients hospitalized with stroke develop delirium at higher rates than general hospitalized patients. While several medications are associated with existing delirium, it is unknown whether early medication exposures are associated with subsequent delirium in patients with stroke. Additionally, it is unknown whether delirium identification is associated with changes in the prescription of these medications.
We conducted a retrospective cohort study of patients admitted to a comprehensive stroke center, who were assessed for delirium by trained nursing staff during clinical care. We analyzed exposures to multiple medication classes in the first 48 h of admission, and compared them between patients who developed delirium >48 hours after admission and those who never developed delirium. Statistical analysis was performed using univariate testing. Multivariable logistic regression was used further to evaluate the significance of univariately significant medications, while controlling for clinical confounders.
1671 unique patients were included in the cohort, of whom 464 (27.8%) developed delirium >48 hours after admission. Delirium was associated with prior exposure to antipsychotics, sedatives, opiates, and antimicrobials. Antipsychotics, sedatives, and antimicrobials remained significantly associated with delirium even after accounting for several clinical covariates. Usage of these medications decreased in the 48 hours following delirium identification, except for atypical antipsychotics, whose use increased. Other medication classes such as steroids, benzodiazepines, and sleep aids were not initially associated with subsequent delirium, but prescription patterns still changed after delirium identification.
Early exposure to multiple medication classes is associated with the subsequent development of delirium in patients with stroke. Additionally, prescription patterns changed following delirium identification, suggesting that some of the associated medication classes may represent modifiable targets for future delirium prevention strategies, although future study is needed.
与一般住院患者相比，因中风住院的患者发生谵妄的比例更高。虽然有几种药物与现有的谵妄有关，但尚不清楚中风患者早期的药物暴露是否与随后的谵妄有关。此外，尚不清楚谵妄的识别是否与这些药物的处方变化有关。
我们进行了一项回顾性队列研究，纳入了入住综合中风中心的患者，由经过培训的护理人员在临床护理期间对其进行谵妄评估。我们分析了入院后 48 小时内的多种药物类别的暴露情况，并将其与入院后 48 小时以上发生谵妄的患者和从未发生谵妄的患者进行比较。使用单变量检验进行统计分析。进一步使用多变量逻辑回归来评估在控制临床混杂因素的情况下，单变量有意义的药物的重要性。
该队列纳入了 1671 名患者，其中 464 名（27.8%）在入院后 48 小时以上发生谵妄。谵妄与先前接触抗精神病药、镇静剂、阿片类药物和抗生素有关。即使考虑到几个临床混杂因素，抗精神病药、镇静剂和抗生素与谵妄仍有显著相关性。在谵妄识别后 48 小时内，这些药物的使用减少了，但除了非典型抗精神病药的使用增加了。其他药物类别，如皮质类固醇、苯二氮䓬类和助眠药，最初与随后的谵妄无关，但在谵妄识别后，处方模式仍发生了变化。
早期接触多种药物类别与中风患者随后发生谵妄有关。此外，在谵妄识别后，处方模式发生了变化，这表明一些相关的药物类别可能是未来谵妄预防策略的可修改目标，但需要进一步研究。
