Current practices in delirium prevention and treatment after acute stroke: results of a multicentre survey.

BACKGROUND: Delirium affects 10-30% of acute stroke patients, is associated with poor outcomes and places a substantial burden on healthcare staff. Evidence-based prevention and treatment strategies are limited, resulting in heterogeneous and poorly standardised delirium management in acute stroke care. OBJECTIVES: We aimed to describe real-world delirium management in German and Austrian stroke units (SUs) and to delineate the extent of practice variation in prevention and treatment. DESIGN: We conducted a cross-sectional, web-based survey of stroke neurologists working at SUs in Austria and Germany. METHODS: The 30-item questionnaire assessed professional background, delirium prevention and pharmacological treatment approaches. Descriptive statistics and exploratory subgroup analyses were performed. RESULTS: Seventy responses from 63 SUs were analysed (median physician SU experience, 14.5 years). Delirium was estimated to affect 20% of patients and was perceived as highly burdensome for both physicians and nurses (median score, 9/10 each). Delirium prevention measures were established in 42 (67%) SUs but routinely applied to all patients in only 12 (19%), mainly due to staffing shortages (nurses, 48%; physicians, 25%). Pharmacological delirium treatment was reported by all respondents. Benzodiazepines were preferred for alcohol withdrawal delirium (60%) and antipsychotics for hyperactive or mixed delirium (59%). α2-Agonists were the most common escalation therapy across these subtypes (46%-67%). CONCLUSION: Delirium management in German and Austrian SUs is highly heterogeneous, limited by staffing constraints and strongly relies on non-evidence-based pharmacological strategies. These findings highlight critical gaps in care and call for enhanced staffing and stroke-specific trials to inform evidence-based delirium management.