%0 Journal Article
%T Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland
%A Gail Carin-Levy
%A Kath Nicol
%A Frederike van Wijck
%A Gillian E. Mead
%J ISRN Stroke
%D 2013
%R 10.1155/2013/620186
%X Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended. 1. Introduction Delirium is a common neuropsychiatric condition affecting 20¨C30% of elderly patients across most hospital settings [1]. In acute stroke, the incidence of delirium reported by individual studies ranges from 10% [2] to 48% [3], and meta analyses recently performed placed the incidence around 26%¨C28% [4, 5]. Delirium is associated with increased mortality, morbidity, and length of hospital stay [5¨C8], and it has been strongly associated with development of cognitive impairment in the long term in the general medical setting [9, 10]. In acute stroke, recent studies have clearly demonstrated that patients who develop delirium are more likely to die within 12 months, have poorer functional outcomes, and are at higher risk of developing dementia [4, 5, 11, 12]. There are calls in the literature for clinicians to place an emphasis on early identification of delirium in stroke patients, using a tool validated specifically for this population, as early intervention may minimise the aforementioned unfavourable outcomes [5, 13, 14]. The most recent guidance published in the United Kingdom (UK) by both the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Physicians
%U http://www.hindawi.com/journals/isrn.stroke/2013/620186/