In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium

Farhaan S. Vahidy, Arvind B. Bambhroliya, Jennifer R. Meeks, Omar Rahman, E. Wesley Ely, Arjen J.C. Slooter, Jon E. Tyson, Charles C. Miller, Louise D. McCullough, Sean I. Savitz, Babar Khan

Research output: Contribution to journalArticle

Abstract

Objective Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients. Methods We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95% confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes. Results We identified 3,107,437 stroke discharges of whom 7.45% were coded to have delirium. This proportion significantly increased between 2010 (6.3%) and 2015 (8.7%) (aOR, 95% CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0%, SAH: 9.8%) as compared to IS patients (7.0%). Delirious stroke patients had higher in-hospital

mortality (12.3% vs. 7.8%), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7%) as compared to those without delirium (12.2%) (aRR, 95% CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3% vs. 6.4%). Conclusion Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.

Original languageEnglish (US)
Article numbere0225204
JournalPLoS ONE
Volume14
Issue number11
DOIs
StatePublished - Jan 1 2019

Fingerprint

Delirium
stroke
Stroke
confidence interval
Length of Stay
International Classification of Diseases
Confidence Intervals
Hospital Mortality
Logistics
Patient Readmission
odds ratio
Critical Illness
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Vahidy, F. S., Bambhroliya, A. B., Meeks, J. R., Rahman, O., Wesley Ely, E., Slooter, A. J. C., ... Khan, B. (2019). In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium. PLoS ONE, 14(11), [e0225204]. https://doi.org/10.1371/journal.pone.0225204

In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium. / Vahidy, Farhaan S.; Bambhroliya, Arvind B.; Meeks, Jennifer R.; Rahman, Omar; Wesley Ely, E.; Slooter, Arjen J.C.; Tyson, Jon E.; Miller, Charles C.; McCullough, Louise D.; Savitz, Sean I.; Khan, Babar.

In: PLoS ONE, Vol. 14, No. 11, e0225204, 01.01.2019.

Research output: Contribution to journalArticle

Vahidy, FS, Bambhroliya, AB, Meeks, JR, Rahman, O, Wesley Ely, E, Slooter, AJC, Tyson, JE, Miller, CC, McCullough, LD, Savitz, SI & Khan, B 2019, 'In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium', PLoS ONE, vol. 14, no. 11, e0225204. https://doi.org/10.1371/journal.pone.0225204
Vahidy FS, Bambhroliya AB, Meeks JR, Rahman O, Wesley Ely E, Slooter AJC et al. In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium. PLoS ONE. 2019 Jan 1;14(11). e0225204. https://doi.org/10.1371/journal.pone.0225204
Vahidy, Farhaan S. ; Bambhroliya, Arvind B. ; Meeks, Jennifer R. ; Rahman, Omar ; Wesley Ely, E. ; Slooter, Arjen J.C. ; Tyson, Jon E. ; Miller, Charles C. ; McCullough, Louise D. ; Savitz, Sean I. ; Khan, Babar. / In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium. In: PLoS ONE. 2019 ; Vol. 14, No. 11.
@article{0d6c2e86c30a49f4aafafe6c8fac6724,
title = "In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium",
abstract = "Objective Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients. Methods We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95{\%} confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes. Results We identified 3,107,437 stroke discharges of whom 7.45{\%} were coded to have delirium. This proportion significantly increased between 2010 (6.3{\%}) and 2015 (8.7{\%}) (aOR, 95{\%} CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0{\%}, SAH: 9.8{\%}) as compared to IS patients (7.0{\%}). Delirious stroke patients had higher in-hospitalmortality (12.3{\%} vs. 7.8{\%}), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7{\%}) as compared to those without delirium (12.2{\%}) (aRR, 95{\%} CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3{\%} vs. 6.4{\%}). Conclusion Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.",
author = "Vahidy, {Farhaan S.} and Bambhroliya, {Arvind B.} and Meeks, {Jennifer R.} and Omar Rahman and {Wesley Ely}, E. and Slooter, {Arjen J.C.} and Tyson, {Jon E.} and Miller, {Charles C.} and McCullough, {Louise D.} and Savitz, {Sean I.} and Babar Khan",
year = "2019",
month = "1",
day = "1",
doi = "10.1371/journal.pone.0225204",
language = "English (US)",
volume = "14",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "11",

}

TY - JOUR

T1 - In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium

AU - Vahidy, Farhaan S.

AU - Bambhroliya, Arvind B.

AU - Meeks, Jennifer R.

AU - Rahman, Omar

AU - Wesley Ely, E.

AU - Slooter, Arjen J.C.

AU - Tyson, Jon E.

AU - Miller, Charles C.

AU - McCullough, Louise D.

AU - Savitz, Sean I.

AU - Khan, Babar

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients. Methods We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95% confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes. Results We identified 3,107,437 stroke discharges of whom 7.45% were coded to have delirium. This proportion significantly increased between 2010 (6.3%) and 2015 (8.7%) (aOR, 95% CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0%, SAH: 9.8%) as compared to IS patients (7.0%). Delirious stroke patients had higher in-hospitalmortality (12.3% vs. 7.8%), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7%) as compared to those without delirium (12.2%) (aRR, 95% CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3% vs. 6.4%). Conclusion Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.

AB - Objective Delirium is associated with poor outcomes among critically ill patients. However, it is not well characterized among patients with ischemic or hemorrhagic stroke (IS and HS). We provide the population-level frequency of in-hospital delirium and assess its association with in-hospital outcomes and with 30-day readmission among IS and HS patients. Methods We analyzed Nationwide in-hospital and readmission data for years 2010–2015 and identified stroke patients using ICD-9 codes. Delirium was identified using validated algorithms. Outcomes were in-hospital mortality, length of stay, unfavorable discharge disposition, and 30-day readmission. We used survey design logistic regression methods to provide national estimates of proportions and 95% confidence intervals (CI) for delirium, and odds ratios (OR) for association between delirium and poor outcomes. Results We identified 3,107,437 stroke discharges of whom 7.45% were coded to have delirium. This proportion significantly increased between 2010 (6.3%) and 2015 (8.7%) (aOR, 95% CI: 1.04, 1.03–1.05). Delirium proportion was higher among HS patients (ICH: 10.0%, SAH: 9.8%) as compared to IS patients (7.0%). Delirious stroke patients had higher in-hospitalmortality (12.3% vs. 7.8%), longer in-hospital stay (11.6 days vs. 7.3 days) and a significantly greater adjusted risk of 30-day-readmission (16.7%) as compared to those without delirium (12.2%) (aRR, 95% CI: 1.13, 1.11–1.15). Upon readmission, patients with delirium at initial admission continued to have a longer length of stay (7.7 days vs. 6.6 days) and a higher in-hospital mortality (9.3% vs. 6.4%). Conclusion Delirium identified through claims data in stroke patients is independently associated with poor in-hospital outcomes both at index admission and readmission. Identification and management of delirium among stroke patients provides an opportunity to improve outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85075115244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075115244&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0225204

DO - 10.1371/journal.pone.0225204

M3 - Article

C2 - 31725810

AN - SCOPUS:85075115244

VL - 14

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 11

M1 - e0225204

ER -