Table 1 Main data extracted from the included studies
From: Detecting delirium in patients with acute stroke: a systematic review of test accuracy
Author, year [reference] | Study design, Country | Aims | Evaluated tools, language | Gold standard/alternative methods(s) considered | Diagnostic practice | Examiner(s) | Patients: inclusion/exclusion criteria | Patients: sample methods and main profile |
|---|---|---|---|---|---|---|---|---|
Infante et al., 2017 [20] | Diagnostic test accuracy study quasi-experimental studya Italy | 1. To assess the effect of DSM-V delirium criteria review and formal training on the ability of neurologists to recognise delirium 2. To evaluate the 4AT for the evaluation of post-stroke delirium | 4AT Language: Italian | DSM-V criteria | Delirium was screened with 4AT and assessed with DSM-V criteria at admission and after 7 days of hospitalisation by the same researcher All diagnoses were afterwards reviewed independently by other two expert researchers Period: NR Setting: single tertiary stroke centre | Three neurologists | Inclusion criteria (diagnostic test accuracy study): • > 18 years • diagnosis of acute stroke • GCS > 5 Exclusion criteria: • aphasia • dementia | Consecutive sample n = 100; median age 79 years; gender NR |
Kutlubaev et al., 2016 [21] | Diagnostic test accuracy study and observational studya Russia | 1. To identify older patients with high delirium risk 2. To assess the diagnostic value of the 4AT test in this population | 4AT Language: Russian | DSM-IV criteria | Patients were examined for delirium within hours after their admission or on the next day; then twice at the interval of 12–24 h during their in-hospital stay Delirium was diagnosed according to the DSM-IV criteria and the 4AT test Period: 2 months (2013–2014) Setting: Neurovascular Department | Neurologist (not specified if the same, or not, who evaluated the delirium presence with both the 4AT and the DSM-IV criteria) | Inclusion criteria: • ≥ 65 years • admitted in the first 3 days of stroke Exclusion criteria: • subarachnoid/subdural haemorrhages without intracerebral haematoma • transient ischaemic attacks • impairment of consciousness as severe as sopor and coma • with significant chronic mental disorders in the past | Consecutive sample n = 73 (over 132 eligible); median age 79 years; male 29% |
Lees et al., 2013 [22] | Diagnostic test accuracy study United Kingdom | 1. To describe test accuracy properties of various brief screening assessments against an independent clinical diagnosis of cognitive impairment (using MoCA) and delirium 2. To describe the effect of altering the screen-positive cut-point for MoCA using differing predetermined diagnostic thresholds | AMT-10 AMT-4 CDT COG-4 4AT GCS Single Question “Does this patient have cognitive issues?” at the daily multidisciplinary team Language: English | CAM | Patients were assessed during the period of day 1 to day 4 after stroke unit admission Period: 10 weeks (April–June 2012) Setting: Stroke Unit | Two trained medical students: one completed the delirium assessment using the validating tools; one assessed for delirium using the CAM They were blinded | Inclusion criteria: • cerebral ischaemia and haemorrhage • medically stable to allow an attempt at a least part of cognitive assessment Exclusion criteria: NR | Consecutive sample n = 111 (over 138 eligible); median age 74 years; male 50% |
Mitasova et al., 2012 [8] | Diagnostic test accuracy study and observational studya Czech Republic | 1. To describe the epidemiology of delirium in a cohort of acute post-stroke patients using the DSM-IV 2. To determine the sensitivity, specificity, and overall accuracy of the CAM-ICU, and 3. To investigate its validity as a routine monitoring instrument for hospitalised patients with stroke by non-psychiatrically trained clinicians | CAM-ICU Language: Czech | DSM-IV criteria | Patients underwent paired daily evaluation with the CAM-ICU The first CAM-ICU evaluation on the first day after stroke onset and admission (day 1) and then daily (6 days/week) on at least 7 consecutive days on which the patient was accessible to testing (RASS ≥ −3). If delirium was present on day 6 or 7, its assessment follow-up continued until at least 2 subsequent days without delirium were recorded In patients with consciousness deterioration the follow-up was stopped The standard DSM evaluation of delirium was performed < 2 h apart daily Period: 18 months (2009–2010) Setting: specialised stroke centre | A trained junior physician assessed patients with the CAM-ICU A panel of specialists, experts on delirium (two neurologists, two neuropsychologists, a psychiatrist and a speech therapist) performed the standard reference DSM evaluation (at least one neurologist and one neuropsychologist) | Inclusion criteria: • cerebral infarction or intracerebral haemorrhage • delirium assessment within 24 h of stroke onset • approval of the patient or his or her relatives Exclusion criteria: • patients who did not speak Czech • duration of stroke symptoms and signs < 24 h • history of severe head trauma or neurosurgery (at any time) • subarachnoid haemorrhage, venous infarction, brain tumour • history of psychosis • patients who were comatose or stuporous on admission and did not improve during the first week post-stroke (RASS ≤ − 4) | Consecutive sample n = 129 (151 initially enrolled, over 331 eligible); mean age 71.3 years; male 55.8% |