Association of Delirium Incidence with Visitation Restrictions due to COVID-19 Pandemic in Patients with Acute Cerebrovascular Disease in a Stroke-Unit Setting: A Retrospective Cohort Study

Abstract

<b><i>Introduction:</i></b> Hospitals around the world introduced considerable visitation restrictions to reduce risk of infection during epidemic spread of SARS-CoV2. Understanding of negative impacts of visitation restrictions on subgroups of patients may help to balance and adjust policies accordingly or introduce further measures to mitigate their impact. We aimed to investigate the association of visitation restrictions with delirium incidence in stroke-unit patients. <b><i>Methods:</i></b> In a non-randomized observational design, data from 5,779 stroke-unit cases with transient ischemic attack or stroke (ischemic/hemorrhagic) admitted between January 2017 and November 2021 were compared between three groups depending on visitation policy implemented at time of admission: pandemic-associated absolute visitation restriction (<i>n</i> = 1,087), limited visitation policy (<i>n</i> = 862), and pre-pandemic visitation policy (<i>n</i> = 3,830). Univariate comparison and multiple logistic regression analyses were conducted to evaluate the association of delirium with visitation restrictions. <b><i>Results:</i></b> We observed delirium incidences of 6.3% during pandemic-associated absolute visitation restriction, 5.8% with limited visitation policy, and 5.1% with pre-pandemic visitation policy (<i>p</i> = 0.239). In multiple logistic regression analyses adjusting for clinically relevant variables, we found the presence of any pandemic-associated visitation restriction (odds ratio [OR] 1.363, 95% confidence interval [CI]: 1.066–1.744, <i>p</i> = 0.014) and specifically absolute visitation restriction (OR 1.368, 95% CI: 1.016–1.843, <i>p</i> = 0.039) independently associated with delirium in patients with acute cerebrovascular disease. Other factors independently associated with delirium were older age, male sex, stroke versus transient ischemic attack, acute infection, history of dementia, and longer duration of hospital stay. <b><i>Conclusion:</i></b> Pandemic-associated visitation restrictions and specifically absolute visitation restrictions are associated with a higher incidence of delirium among stroke-unit patients with acute cerebrovascular disease. Benefit and harm of visitation restrictions should be carefully weighed and adjustments considered for patients otherwise at increased risk for delirium.