The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters
Background and objectivePost-stroke delirium (PSD) is a common complication in acute stroke patients, and guidelines recommend routine screening and various preventive and treatment measures. However, there is a substantial lack of standardized approaches in diagnostic and therapeutic management of...
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| Format: | Article |
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Frontiers Media S.A.
2023-12-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1306520/full |
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| author | Johannes Wischmann Pauline Kremer Ludwig Hinske Ludwig Hinske Roland Tomasi Andrea S. Becker-Pennrich Andrea S. Becker-Pennrich Lars Kellert |
| author_facet | Johannes Wischmann Pauline Kremer Ludwig Hinske Ludwig Hinske Roland Tomasi Andrea S. Becker-Pennrich Andrea S. Becker-Pennrich Lars Kellert |
| author_sort | Johannes Wischmann |
| collection | DOAJ |
| description | Background and objectivePost-stroke delirium (PSD) is a common complication in acute stroke patients, and guidelines recommend routine screening and various preventive and treatment measures. However, there is a substantial lack of standardized approaches in diagnostic and therapeutic management of PSD. Here, we aimed to develop a new pragmatic and easily assessable screening tool to predict PSD based on early parameters, which are already integral to acute stroke diagnostics.MethodsWe enrolled acute stroke patients admitted to our stroke unit or intensive care unit and developed the scoring system using retrospective single-center patient data. The Confusion Assessment Method for the Intensive Care Unit was used for prospective score validation. Logistic regression models were employed to analyze the association of early clinical and paraclinical parameters with PSD development.ResultsN = 525 patients (median age: 76 years; 45.7% female) were enrolled, with 29.7% developing PSD during hospitalization. The resulting score comprises 6 items, including medical history, clinical examination findings, and non-contrast computed tomography results at admission. Scores range from −15 to +15 points, with higher values indicating a higher likelihood of PSD, ranging from 4% to 79%. The accuracy was 0.85, and the area under the curve was 0.89.ConclusionThe new RAPID (Risk Assessment and PredIction of Delirium in acute stroke patients)-score shows high accuracy in predicting PSD among acute stroke patients and offers precise odds of PSD for each corresponding score value, utilizing routine early clinical and paraclinical parameters. It can identify high-risk populations for clinical study interventions and may be suitable to guide prophylactic PSD measures. |
| first_indexed | 2024-03-08T23:05:11Z |
| format | Article |
| id | doaj.art-2b125ad2c81245a79027d6348bcbbf63 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-08T23:05:11Z |
| publishDate | 2023-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-2b125ad2c81245a79027d6348bcbbf632023-12-15T13:51:46ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-12-011410.3389/fneur.2023.13065201306520The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parametersJohannes Wischmann0Pauline Kremer1Ludwig Hinske2Ludwig Hinske3Roland Tomasi4Andrea S. Becker-Pennrich5Andrea S. Becker-Pennrich6Lars Kellert7Department of Neurology, LMU University Hospital, LMU Munich, Munich, GermanyDepartment of Neurology, LMU University Hospital, LMU Munich, Munich, GermanyDepartment of Anesthesiology, LMU University Hospital, LMU Munich, Munich, GermanyInstitute for Digital Medicine, University Hospital Augsburg, Augsburg, GermanyDepartment of Anesthesiology, LMU University Hospital, LMU Munich, Munich, GermanyDepartment of Anesthesiology, LMU University Hospital, LMU Munich, Munich, GermanyFaculty of Medicine, Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, GermanyDepartment of Neurology, LMU University Hospital, LMU Munich, Munich, GermanyBackground and objectivePost-stroke delirium (PSD) is a common complication in acute stroke patients, and guidelines recommend routine screening and various preventive and treatment measures. However, there is a substantial lack of standardized approaches in diagnostic and therapeutic management of PSD. Here, we aimed to develop a new pragmatic and easily assessable screening tool to predict PSD based on early parameters, which are already integral to acute stroke diagnostics.MethodsWe enrolled acute stroke patients admitted to our stroke unit or intensive care unit and developed the scoring system using retrospective single-center patient data. The Confusion Assessment Method for the Intensive Care Unit was used for prospective score validation. Logistic regression models were employed to analyze the association of early clinical and paraclinical parameters with PSD development.ResultsN = 525 patients (median age: 76 years; 45.7% female) were enrolled, with 29.7% developing PSD during hospitalization. The resulting score comprises 6 items, including medical history, clinical examination findings, and non-contrast computed tomography results at admission. Scores range from −15 to +15 points, with higher values indicating a higher likelihood of PSD, ranging from 4% to 79%. The accuracy was 0.85, and the area under the curve was 0.89.ConclusionThe new RAPID (Risk Assessment and PredIction of Delirium in acute stroke patients)-score shows high accuracy in predicting PSD among acute stroke patients and offers precise odds of PSD for each corresponding score value, utilizing routine early clinical and paraclinical parameters. It can identify high-risk populations for clinical study interventions and may be suitable to guide prophylactic PSD measures.https://www.frontiersin.org/articles/10.3389/fneur.2023.1306520/fulldeliriumacute strokeprediction scorestroke unitintensive care unitpost-stroke delirium |
| spellingShingle | Johannes Wischmann Pauline Kremer Ludwig Hinske Ludwig Hinske Roland Tomasi Andrea S. Becker-Pennrich Andrea S. Becker-Pennrich Lars Kellert The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters Frontiers in Neurology delirium acute stroke prediction score stroke unit intensive care unit post-stroke delirium |
| title | The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters |
| title_full | The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters |
| title_fullStr | The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters |
| title_full_unstemmed | The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters |
| title_short | The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters |
| title_sort | rapid score risk assessment and prediction of delirium in acute stroke patients based on very early clinical parameters |
| topic | delirium acute stroke prediction score stroke unit intensive care unit post-stroke delirium |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1306520/full |
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