Associations between early in-hospital medications and the development of delirium in patients with stroke

Abstract

ABSTRACTObjectivesPatients hospitalized with stroke develop delirium at higher rates than general hospitalized patients. While several medications are associated with existing delirium, it is unknown whether early medication exposures are associated with subsequent delirium in patients with stroke. Additionally, it is unknown whether delirium identification is associated with changes in the prescription of these medications.Materials and MethodsWe conducted a retrospective cohort study of patients admitted to a comprehensive stroke center, who were assessed for delirium by trained nursing staff during clinical care. We analyzed exposures to multiple medication classes in the first 48 hours of admission, and compared them between patients who developed delirium >48 hours after admission and those who never developed delirium. Statistical analysis was performed using univariate testing and multivariable logistic regression.Results1,710 unique patients were included in the cohort, of whom 471 (27.5%) developed delirium >48 hours after admission. Delirium was associated with prior exposure to antipsychotics, sedatives, opiates, and antimicrobials, even after accounting for several clinical covariates. Usage of these medications decreased in the 48 hours following delirium identification, except for atypical antipsychotics, whose use increased. Other medication classes such as steroids, benzodiazepines, and sleep aids were not initially associated with subsequent delirium, but prescription patterns still changed after delirium identification.ConclusionsEarly exposure to multiple medication classes is associated with the subsequent development of delirium in patients with stroke. Additionally, prescription patterns changed following delirium identification, suggesting that these medication classes may be modifiable targets for future delirium prevention strategies.140-character messageEarly exposure to specific medication classes is associated with delirium in patients with stroke & may be targets for future prevention.@SophiaLRyan, @ekimchi, @MGHNeurology, @MSHSNeurology, @NMNeurology