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The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage.

Publication ,  Journal Article
Reznik, ME; Moody, S; Murray, K; Costa, S; Grory, BM; Madsen, TE; Mahta, A; Wendell, LC; Thompson, BB; Rao, SS; Stretz, C; Sheth, KN ...
Published in: Neurology
November 17, 2020

OBJECTIVE: To determine the impact of delirium on withdrawal of life-sustaining treatment (WLST) after intracerebral hemorrhage (ICH) in the context of established predictors of poor outcome, using data from an institutional ICH registry. METHODS: We performed a single-center cohort study on consecutive patients with ICH admitted over 12 months. ICH features were prospectively adjudicated, and WLST and corresponding hospital day were recorded retrospectively. Patients were categorized using DSM-5 criteria as never delirious, ever delirious (either on admission or later during hospitalization), or persistently comatose. We determined the impact of delirium on WLST using Cox regression models adjusted for demographics and ICH predictors (including Glasgow Coma Scale score), then used logistic regression with receiver operating characteristic curve analysis to compare the accuracy of ICH score-based models with and without delirium category in predicting WLST. RESULTS: Of 311 patients (mean age 70.6 ± 15.6, median ICH score 1 [interquartile range 1-2]), 50% had delirium. WLST occurred in 26%, and median time to WLST was 1 day (0-6). WLST was more frequent in patients who developed delirium (adjusted hazard ratio 8.9 [95% confidence interval (CI) 2.1-37.6]), with high rates of WLST in both early (occurring ≤24 hours from admission) and later delirium groups. An ICH score-based model was strongly predictive of WLST (area under the curve [AUC] 0.902 [95% CI 0.863-0.941]), and the addition of delirium category further improved the model's accuracy (AUC 0.936 [95% CI 0.909-0.962], p = 0.004). CONCLUSION: Delirium is associated with WLST after ICH regardless of when it occurs. Further study on the impact of delirium on clinician and surrogate decision-making is warranted.

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Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

November 17, 2020

Volume

95

Issue

20

Start / End Page

e2727 / e2735

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Registries
  • Prognosis
  • Outcome and Process Assessment, Health Care
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Life Support Care
  • Humans
  • Female
 

Citation

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Reznik, M. E., Moody, S., Murray, K., Costa, S., Grory, B. M., Madsen, T. E., … Furie, K. L. (2020). The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage. Neurology, 95(20), e2727–e2735. https://doi.org/10.1212/WNL.0000000000010738
Reznik, Michael E., Scott Moody, Kayleigh Murray, Samantha Costa, Brian Mac Grory, Tracy E. Madsen, Ali Mahta, et al. “The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage.Neurology 95, no. 20 (November 17, 2020): e2727–35. https://doi.org/10.1212/WNL.0000000000010738.
Reznik ME, Moody S, Murray K, Costa S, Grory BM, Madsen TE, et al. The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage. Neurology. 2020 Nov 17;95(20):e2727–35.
Reznik, Michael E., et al. “The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage.Neurology, vol. 95, no. 20, Nov. 2020, pp. e2727–35. Pubmed, doi:10.1212/WNL.0000000000010738.
Reznik ME, Moody S, Murray K, Costa S, Grory BM, Madsen TE, Mahta A, Wendell LC, Thompson BB, Rao SS, Stretz C, Sheth KN, Hwang DY, Zahuranec DB, Schrag M, Daiello LA, Asaad WF, Jones RN, Furie KL. The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage. Neurology. 2020 Nov 17;95(20):e2727–e2735.

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

November 17, 2020

Volume

95

Issue

20

Start / End Page

e2727 / e2735

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Registries
  • Prognosis
  • Outcome and Process Assessment, Health Care
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Life Support Care
  • Humans
  • Female