Vahidy, Farhaan S.Bambhroliya, Arvind B.Meeks, Jennifer R.Rahman, OmarEly, E. WesleySlooter, Arjen J. C.Tyson, Jon E.Miller, Charles C.McCullough, Louise D.Savitz, Sean I.Khan, Babar2020-01-082020-01-082019-11-14Vahidy, F. S., Bambhroliya, A. B., Meeks, J. R., Rahman, O., Ely, E. W., Slooter, A., … Khan, B. (2019). In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium. PloS one, 14(11), e0225204. doi:10.1371/journal.pone.0225204https://hdl.handle.net/1805/21781OBJECTIVE: 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%). Delirious stroke patients had higher in-hospital 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.en-USDeliriumIschemic strokeHemorrhagic strokeIn-hospital deliriumArticle