Hyperactive delirium in patients after non-traumatic subarachnoid hemorrhage

Purpose: Hyperactive delirium is common after subarachnoid hemorrhage (SAH). We aimed to identify risk fac-tors for delirium and to evaluate its impact on outcome. Methods: We collected daily Richmond Agitation Sedation Scale (RASS) and Intensive Care Delirium Screening Checklist (ICDSC) scores in 276 SAH patients. Hyperactive delirium was defined as ICDSC >= 4 when RASS was > 0. We investigated risk factors for delirium and its association with 3-month functional outcome using gener-alized linear models. Results: Patients were 56 (IQR 47-67) years old and had a Hunt&Hess (H&H) grade of 3 (IQR 1-5). Sixty-five pa-tients (24%) developed hyperactive delirium 6 (IQR 3-16) days after SAH. In multivariable analysis, mechanical ventilation > 48 h (adjOR = 4.46; 95%-CI = 1.89-10.56; p = 0.001), the detection of an aneurysm (adjOR = 4.38; 95%-CI = 1.48-12.97; p = 0.008), a lower H&H grade (adjOR = 0.63; 95%-CI = 0.48-0.83; p = 0.001) and a pre-treated psychiatric disorder (adjOR = 3.17; 95%-CI = 1.14-8.83; p = 0.027) were associated with the develop-ment of delirium. Overall, delirium was not associated with worse outcome (p = 0.119). Interestingly, patients with delirium more often had a modified Rankin Scale Score (mRS) of 1-3 (77%) compared to an mRS of 0 (14%) or 4-6 (9%). Conclusion: Our data indicate that hyperactive delirium is common after SAH patients and requires a certain de-gree of brain connectivity based ono the highest prevalence found in SAH patients with intermediate outcomes. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Automated summary

The study investigated the risk factors and impact of hyperactive delirium in SAH patients. Mechanical ventilation over 48 hours, detection of an aneurysm, lower Hunt&Hess grade, and pre-treated psychiatric disorder were associated with delirium development. Overall, delirium was not associated with worse outcome, but patients with delirium often had intermediate outcomes based on modified Rankin Scale Score.