Diagnostic Accuracy of CAM-ICU and ICDSC for Detection of Early Delirium in Acute Ischemic Stroke: A Cross-sectional Study

Background and Objectives: Early post-stroke delirium (PSD) is difficult to diagnose and complicates recovery. We aimed to evaluate two validated delirium screening tools, focusing on patients with stroke-related higher-order cognitive deficits (HOCDs). Methods: We prospectively analyzed the delirium features and compared the diagnostic accuracy of the Confusion Assessment Method for ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) with Diagnostic and Statistical Manual -5 (DSM-5) criteria in 164 patients with acute ischemic stroke. Early PSD was defined as delirium occurring within 72 h of admission. Results: Early PSD occurred in 32.3% patients, two-thirds of whom had HOCDs such as aphasia or neglect. Individual delirium features were frequent in nondelirious patients with HOCDs, inattention (Area under curve [AUC] .98, odds ratio [OR] 28.88), psychomotor changes (AUC.95, OR 10.60), and impaired arousal (AUC.95, OR 8.57) had maximum discriminating value on logistic regression analysis. When compared with DSM-5, CAM-ICU (sensitivity 81%, specificity 84%, AUC.97) had better accuracy than ICDSC (sensitivity 70%, specificity 86%, AUC.96); however, both were noninferior. In patients with HOCDs, both had markedly reduced specificities. Adding psychomotor changes to patients who were CAM-ICU positive (CAM-ICU Plus) improved its specificity. CAM-ICU Plus (sensitivity 79%, specificity 92%, AUC.98) had the best accuracy among all the tools. Conclusions: Early PSD is common after ischemic stroke. Available screening tools have lower specificity in patients with post-stroke cognitive deficits. CAM-ICU performed better than ICDSC. CAM ICU Plus improves the specificity of CAM ICU, which needs to be confirmed by further multicenter studies. Stroke-specific delirium screening tools are required for improving outcomes.