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Uncomfortable care tied to delirium in acute stroke patients

Journal of the Neurological Sciences
Reuters Health -  11/12/2020 -  Acute stroke patients who experience immobilizing care or frequent nighttime disturbances for care are more likely to develop delirium than those who don't receive this type of uncomfortable care, a recent study suggests.

Researchers examined data on 387 acute stroke patients, including 188 who received at least one type of care associated with delirium, such as restraints, prohibited self-transfer, prohibited oral feeding, indwelling catheters, frequent nighttime care, and histamine H2-antagonists. Overall, 42 patients developed delirium.

Patients who experienced any of these types of care were more likely to develop delirium (relative risk 4.5), and experiencing multiple uncomfortable care types was associated with a further risk increase (RR 5.1).

"Although patients with a potential for reducing uncomfortable care constitute a relatively small proportion of patients, they constitute a substantial proportion of patients who were given uncomfortable care," said senior study author Dr. Ken Johkura of the Yokohama Brain and Spine Center in Japan.

"This suggests there is a substantial potential to reduce the amount of uncomfortable care in acute stroke care, thereby reducing the occurrence of delirium," Dr. Johkura said by email.

For example, while only 32 patients in the study had restraints, 31% of those who did have restraints developed delirium, compared with 9% of those who were not restrained.

And, among the 83 patients who had frequent nighttime care, 24% developed delirium compared with 7% of patients who didn't receive frequent nighttime care.

Histamine H2-antagonists, given to 150 patients (39%), were by far the most common type of care provided with a potential to lead to delirium. However, the increased risk of delirium wasn't as high (RR 1.9) as with other interventions examined in the study, and did not reach statistical significance.

Of all the individual types of care examined, the greatest delirium risk was associated with restraints (RR 3.5), followed by frequent nighttime care (RR 3.3), indwelling catheters (RR 2.8) and prohibited self-transfer (RR 2.7).

Beyond its small size, another limitation of the study is the wide confidence intervals for most of the results, the study team notes in the Journal of the Neurological Sciences.

Even so, the findings suggest that minimizing the amount of uncomfortable care may limit the occurrence of delirium in acute stroke patients, as well as other patients with delirium, said Dr. Katarzyna Kotfis, an associate professor in the department of anesthesiology at Pomeranian Medical University in Szczecin, Poland, who wasn't involved in the study.

"Anything that causes discomfort may cause delirium, including inability to taste and smell food, disruption of nighttime rest or pain related to urinary or venous catheters," Dr. Kotfis said by email. "Moreover, immobility caused by physical restraints may cause confusion and fear and lead to development of bed sores - anything that causes discomfort should be avoided."

SOURCE: https://bit.ly/3mdyKMu Journal of the Neurological Sciences, online November 26, 2020.

By Lisa Rapaport

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