Economic impact of poststroke delirium and associated risk factors : findings from a prospective cohort study

Zipser, Carl Moritz; Deuel, Jeremy Werner; Held, Jeremia Philipp Oskar; Ernst, Jutta; Schubert, Maria; Weller, Michael; Luft, Andreas Rüdiger; von Känel, Roland; Boettger, Soenke

doi:10.1161/STROKEAHA.120.033005

Publication type:	Article in scientific journal
Type of review:	Peer review (publication)
Title:	Economic impact of poststroke delirium and associated risk factors : findings from a prospective cohort study
Authors:	Zipser, Carl Moritz Deuel, Jeremy Werner Held, Jeremia Philipp Oskar Ernst, Jutta Schubert, Maria Weller, Michael Luft, Andreas Rüdiger von Känel, Roland Boettger, Soenke
et. al:	No
DOI:	10.1161/STROKEAHA.120.033005
Published in:	Stroke: A Journal of Cerebral Circulation
Issue Date:	2021
Publisher / Ed. Institution:	Lippincott Williams & Wilkins
ISSN:	0039-2499 1524-4628
Language:	English
Subject (DDC):	616.8: Neurology, diseases of nervous system
Abstract:	Background and Purpose: Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD). Methods: This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD. Results: The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P<0.001), 52% male (115/221) versus 62% non-PSD (214/346) and hospitalized longer (mean 11.5 versus 9.3 days; P<0.001). Dementia was the most relevant predisposing factor for PSD (odds ratio, 16.02 [2.83–90.69], P=0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16–20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15–159.79], P<0.001). PSD was a strong predictor for 3-month mortality (odds ratio, 15.11 [3.33–68.53], P<0.001). Nursing and total costs were nearly twice as high in PSD (P<0.001). There was a positive correlation between total costs and admission National Institutes of Health Stroke Scale (correlation coefficient, 0.491; P<0.001) and length of stay (correlation coefficient, 0.787; P<0.001) in all patients. Quantile regression revealed rising nursing and total costs associated with PSD, higher National Institutes of Health Stroke Scale, and longer hospital stay (all P<0.05). Conclusions: PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.
URI:	https://digitalcollection.zhaw.ch/handle/11475/23087
Fulltext version:	Published version
License (according to publishing contract):	Licence according to publishing contract
Departement:	School of Health Sciences
Organisational Unit:	Institute of Nursing (IPF)
Appears in collections:	Publikationen Gesundheit

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Zipser, C. M., Deuel, J. W., Held, J. P. O., Ernst, J., Schubert, M., Weller, M., Luft, A. R., von Känel, R., & Boettger, S. (2021). Economic impact of poststroke delirium and associated risk factors : findings from a prospective cohort study. Stroke: A Journal of Cerebral Circulation. https://doi.org/10.1161/STROKEAHA.120.033005

Zipser, C.M. et al. (2021) ‘Economic impact of poststroke delirium and associated risk factors : findings from a prospective cohort study’, Stroke: A Journal of Cerebral Circulation [Preprint]. Available at: https://doi.org/10.1161/STROKEAHA.120.033005.

C. M. Zipser et al., “Economic impact of poststroke delirium and associated risk factors : findings from a prospective cohort study,” Stroke: A Journal of Cerebral Circulation, 2021, doi: 10.1161/STROKEAHA.120.033005.

ZIPSER, Carl Moritz, Jeremy Werner DEUEL, Jeremia Philipp Oskar HELD, Jutta ERNST, Maria SCHUBERT, Michael WELLER, Andreas Rüdiger LUFT, Roland VON KÄNEL und Soenke BOETTGER, 2021. Economic impact of poststroke delirium and associated risk factors : findings from a prospective cohort study. Stroke: A Journal of Cerebral Circulation. 2021. DOI 10.1161/STROKEAHA.120.033005

Zipser, Carl Moritz, Jeremy Werner Deuel, Jeremia Philipp Oskar Held, Jutta Ernst, Maria Schubert, Michael Weller, Andreas Rüdiger Luft, Roland von Känel, and Soenke Boettger. 2021. “Economic Impact of Poststroke Delirium and Associated Risk Factors : Findings from a Prospective Cohort Study.” Stroke: A Journal of Cerebral Circulation. https://doi.org/10.1161/STROKEAHA.120.033005.

Zipser, Carl Moritz, et al. “Economic Impact of Poststroke Delirium and Associated Risk Factors : Findings from a Prospective Cohort Study.” Stroke: A Journal of Cerebral Circulation, 2021, https://doi.org/10.1161/STROKEAHA.120.033005.