Incidence of Delirium in Patients with Acute Ischemic Stroke in the Medical Intensive Care Unit at Chiang Mai Neurological Hospital

Abstract

Background: Delirium is a psychiatric syndrome characterized by an altered level of consciousness, commonly observed in patients with acute ischemic stroke. Its incidence is highest in intensive care units, particularly among elderly patients and those with infections. Delirium leads to deterioration in cognitive function, perception, and memory. Symptoms typically occur within 24-72 hours (2-3 days) after hospital admission and may persist for hours, days, or weeks. In some cases, confusion continues even after discharge. Early assessment of delirium enables timely nursing interventions, preventing complications and minimizing adverse outcomes. Objectives: To determine (1) the incidence of delirium in acute ischemic stroke patients admitted to the medical ICU, (2) associated risk factors, and (3) complications related to delirium. Methods: This descriptive study included patients aged 60 years and older diagnosed with acute ischemic stroke and admitted to the medical ICU at Chiang Mai Neurological Hospital between October 2022 and December 2023. A total of 146 participants were assessed using CAM-ICU, RASS, and a complication recording form. Results: The mean age of participants was 70.27 years, with the majority being male (51.4%). Delirium was observed in 7.5% of patients, occurring during initial admission in 6.2% and within 24 hours in 7.5%. Complications were noted within 72 hours in 2.1% Significant risk factors included male sex (13.3% vs. 1.4% in females), age > 80 years (25%), followed by age 70-79 years (8.2%, p = .003), comorbidities (8.3%), smoking (11.3%), and abnormal hematocrit (8.0%). Age showed a statistically significant association, whereas comorbidities did not (p = .730). Conclusion: Delirium is more prevalent among males and patients aged over 80 years with acute ischemic stroke. Routine delirium assessment and monitoring for at least 72 hours after admission are recommended to enable timely management and prevent complications.