OBJECTIVES: The Society of Critical Care Medicine recommends routine delirium monitoring, based on data in critically ill patients without primary neurologic injury. We sought to answer whether there are valid and reliable tools to monitor delirium in neurocritically ill patients and whether delirium is associated with relevant clinical outcomes (e.g., survival, length of stay, functional independence, cognition) in this population. DATA SOURCES: We systematically reviewed Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed. STUDY SELECTION AND DATA EXTRACTION: Inclusion criteria allowed any study design investigating delirium monitoring in neurocritically ill patients (e.g., neurotrauma, ischemic, and/or hemorrhagic stroke) of any age. We extracted data relevant to delirium tool sensitivity, specificity, negative predictive value, positive predictive value, interrater reliability, and associated clinical outcomes. DATA SYNTHESIS: Among seven prospective cohort studies and a total of 1,173 patients, delirium was assessed in neurocritically patients using validated delirium tools after considering primary neurologic diagnoses and associated complications, finding a pooled prevalence rate of 12-43%. When able to compare against a common reference standard, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the test characteristics showed a sensitivity of 62-76%, specificity of 74-98%, positive predictive value of 63-91%, negative predictive value of 70-94%, and reliability kappa of 0.64-0.94. Among four studies reporting multivariable analyses, delirium in neurocritically patients was associated with increased hospital length of stay (n = 3) and ICU length of stay (n = 1), as well as worse functional independence (n = 1) and cognition (n = 2), but not survival. CONCLUSIONS: These data from studies of neurocritically ill patients demonstrate that patients with primary neurologic diagnoses can meet diagnostic criteria for delirium and that delirious features may predict relevant untoward clinical outcomes. There is a need for ongoing investigations regarding delirium in these complicated neurocritically ill patients.

Anesthesiology Service Department of Veterans Affairs Medical Center Tennessee Valley Healthcare System Nashville TN

Applied Neuroscience Research Group Central European Institute of Technology Masaryk University Brno Czech Republic

Center for Knowledge Management Vanderbilt University Medical Center Nashville TN

Critical Illness Brain dysfunction and ICU Survivorship Center Center for Health Services Research Vanderbilt University Medical Center Nashville TN

D'Or Institute for Research and Education Rio De Janeiro Brazil

Department of Anesthesiology Division of Critical Care Medicine Vanderbilt University Medical Center Nashville TN

Department of Intensive Care Gelre Ziekenhuizen the Netherlands

Department of Intensive Care Medicine Brain Center Rudolf Magnus University Medical Center Utrecht the Netherlands

Department of Medicine Division of Allergy Pulmonary and Critical Care Medicine Vanderbilt University Medical Center Nashville TN

Department of Medicine McGill University Montreal QC Canada

Department of Neurology University Hospital Brno Brno Czech Republic

Department of Neurosciences and Department of Public Health University of Naples Naples Italy

Department of Rehabilitation and Aged Care of the Fondazione Camplani Ancelle Hospital Cremona Italy

Departments of Neurology Northwestern University Feinberg School of Medicine Chicago IL

Geriatric Research Education and Clinical Center Department of Veterans Affairs Medical Center Tennessee Valley Healthcare System Nashville TN

Geriatric Research Group Brescia Italy

Intensive Care Lab Instituto Nacioinal de Infectologia Evandro Chagas Rio De Janeiro Brazil

Novant Health Presbyterian Medical Center Charlotte NC

Section of Neurocritical Care Department of Neurological Sciences Rush University Medical Center Chicago IL

Section of Surgical Sciences Departments of Surgery Neurosurgery Hearing and Speech Sciences Division of Trauma Surgical Critical Care and Emergency General Surgery Vanderbilt Brain Institute Vanderbilt University Medical Center Nashville TN

Surgical Service Department of Veterans Affairs Medical Center Tennessee Valley Healthcare System Nashville TN

University New South Wales Clinical School of Medicine Prince of Wales Hospital Randwick NSW Australia

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Crit Care Med. 2018 Nov;46(11):1881-1882. doi: 10.1097/CCM.0000000000003399. PubMed

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