ArticleJournal of critical care2020
Fluctuations of consciousness after stroke: Associations with the confusion assessment method for the intensive care unit (CAM-ICU) and potential undetected delirium.
Article in Journal of critical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 14 citations in OpenAlex.
- Prevention and Treatment of ICU Delirium in Brain Injured Patients.Current neurology and neuroscience reports · 2026Review
- Risk-predicting and screening tools of post-stroke delirium: a narrative review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Review
- Development and validation of a risk prediction model for consciousness disorders in stroke patients in the intensive care unit (ICU): a retrospective study.Frontiers in medicine · 2025Article
- Usefulness of the 4A's test for detecting delirium in critically ill patients: a multicenter prospective observation study.Internal and emergency medicine · 2024Observational
- The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters.Frontiers in neurology · 2023Article
- Delirium detection using wearable sensors and machine learning in patients with intracerebral hemorrhage.Frontiers in neurology · 2023Article
- Optimal strategy for delirium detection in older patients admitted to intensive care unit after non-cardiac surgery.Frontiers in surgery · 2023Article
- The future of intensive care: delirium should no longer be an issue.Critical care (London, England) · 2022Review
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
purposeTo examine associations between fluctuating consciousness and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessments in stroke patients compared to non-neurological patients. MATERIALS AND
methodsWe linked all recorded CAM-ICU assessments with corresponding Richmond Agitation Sedation Scale (RASS) measurements in patients with stroke or sepsis from a single-center ICU database. Fluctuating consciousness was defined by RASS variability using standard deviations (SD) over 24-h periods; regression analyses were performed to determine associations with RASS variability and CAM-ICU rating.
resultsWe identified 16,509 paired daily summaries of CAM-ICU and RASS measurements in 546 stroke patients and 1586 sepsis patients. Stroke patients had higher odds of positive (OR 4.2, 95% CI 3.3-5.5) and "unable to assess" (UTA; OR 5.2, 95% CI 4.0-6.8) CAM-ICU ratings compared to sepsis patients, and CAM-ICU-positive and UTA assessment-days had higher RASS variability than CAM-ICU-negative assessment-days, especially in stroke patients. Based on model-implied associations of RASS variability (OR 2.0 per semi-IQR-difference in RASS-SD, 95% CI 1.7-2.2) and stroke diagnosis (OR 2.7, 95% CI 2.0-3.7) with CAM-ICU-positive assessments, over one-third of probable delirium cases among stroke patients were potentially missed by the CAM-ICU.
conclusionsPost-stroke delirium may frequently go undetected by the CAM-ICU, even in the setting of fluctuating consciousness.
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Registered trials
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