TY - JOUR
T1 - In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium
AU - Vahidy, Farhaan S.
AU - Bambhroliya, Arvind B.
AU - Meeks, Jennifer R.
AU - Rahman, Omar
AU - Wesley Ely, E.
AU - Slooter, Arjen J.C.
AU - Tyson, Jon E.
AU - Miller, Charles C.
AU - McCullough, Louise D.
AU - Savitz, Sean I.
AU - Khan, Babar
N1 - Funding Information:
We acknowledge the infrastructural support provided by the Biostatistics/ Epidemiology/Research Design (BERD) component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by a grant (UL1 TR000371) from the National Center for Advancing Translational Sciences (NCATS), awarded to University of Texas Health Science Center at Houston.
Publisher Copyright:
© 2019 Vahidy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Objective Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients. Methods We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95% confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes. Results We identified 3,107,437 stroke discharges of whom 7.45% were coded to have delirium. This proportion significantly increased between 2010 (6.3%) and 2015 (8.7%) (aOR, 95% CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0%, SAH: 9.8%) as compared to IS patients (7.0%).mortality (12.3% vs. 7.8%), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7%) as compared to those without delirium (12.2%) (aRR, 95% CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3% vs. 6.4%). Conclusion Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.
AB - Objective Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients. Methods We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95% confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes. Results We identified 3,107,437 stroke discharges of whom 7.45% were coded to have delirium. This proportion significantly increased between 2010 (6.3%) and 2015 (8.7%) (aOR, 95% CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0%, SAH: 9.8%) as compared to IS patients (7.0%).mortality (12.3% vs. 7.8%), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7%) as compared to those without delirium (12.2%) (aRR, 95% CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3% vs. 6.4%). Conclusion Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85075115244&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075115244&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0225204
DO - 10.1371/journal.pone.0225204
M3 - Article
C2 - 31725810
AN - SCOPUS:85075115244
SN - 1932-6203
VL - 14
JO - PLoS ONE
JF - PLoS ONE
IS - 11
M1 - e0225204
ER -