Assessing Delirium in Patients With Neurological Diseases

BACKGROUND: Delirium is a common complication during hospitalization. Its consequences are severe, including reduced function, delayed rehabilitation, dementia, institutionalization, and death. Assessing delirium in neurological patients can be challenging due to the impact of neurological deficits. Therefore, the aim was to investigate the agreement between 2 delirium screening tools, factors associated with delirium, and assessing delirium in neurological patients. METHODS: This prospective observational study was conducted in 2 neurological units, using daily delirium screening. Intensive Care Delirium Screening Checklist and 2 versions of the Confusion Assessment Method were used to asses delirium in adult patients without baseline dementia, alcohol/drug detoxification, or palliative care. Descriptive analyses determined the number of delirium scores, and the analytical analyses were logistic regressions and a κ coefficient. RESULTS: The agreement between the screening tools was found to be substantial (κ = 0.71). Logistic regression analysis showed that the risk factors for a positive delirium screening were home care before admission (Confusion Assessment Method: odds ratio OR, 4.21 95% confidence interval (CI), 1.67-10.63; Intensive Care Delirium Screening Checklist: OR, 6.14 95% CI, 2.85-13.23) and aphasia/dysarthria (Confusion Assessment Method: OR, 4.9 95% CI, 1.32-6.81; Intensive Care Delirium Screening Checklist: OR, 2.76 95% CI, 1.3-5.87). In total, 18.7% (n = 20/107) of the screening scores were positive. Specifically, the Confusion Assessment Method showed positive scores for 13.0% (n = 14/107) of participants, whereas the Intensive Care Delirium Screening Checklist showed positive scores for 16.8% (n = 18/107). CONCLUSION: The screening tools had a substantial degree of agreement. Therefore, nurses can use both screening tools to detect delirium in patients with neurological disorders. However, care should be taken in patients with aphasia to avoid misclassification with the Brief-Confusion Assessment Method. Moreover, special attention should be directed toward patients with language difficulties such as aphasia/dysarthria and those who received home care services before admission. These areas warrant further investigation in clinical practice and future studies.