Prevalence of Delirium in Brain Tumor Patients: A Systematic Review and Meta-analysis
Zachary Tentor1, Alexander Finnemore2, Paul Miller1, Joshua Davis1, Erika Juarez Martinez3, Eyal Kimchi4, Charlotta Lindvall1, John Rhee5
1Supportive Oncology, Dana Farber Cancer Institute, 2University of Navarra, 3Neurology, Northwestern University, 4Northwestern University, 5Neuro-Oncology, Dana Farber Cancer Institute, Harvard Medical School
Objective:
To determine the prevalence rates of delirium in hospitalized patients with brain tumors.
Background:
Delirium in hospitalized patients is associated with poor outcomes such as increased morbidity, mortality, and length of hospital stay. Although delirium is frequently reported as a complication of patients with brain tumors, its general prevalence is unknown. 
Design/Methods:

Following PRISMA guidelines, we conducted a systematic review and meta-analysis searching PubMed, Scopus, and Web of Science for prevalence or incidence of delirium in primary and secondary brain tumors. Studies from January 2009 to June 2024 were included. Only high-quality studies were included. We used random-effects models for summary estimates. We performed subgroup analyses by type of tumor, location of tumor, and delirium sub-type. We also analyzed the association of delirium with length of stay. This review was pre-registered on PROSPERO (CRS42024565359).

Results:

Of 452 studies screened, 22 were included, representing 35,484 patients. The overall prevalence of delirium in patients with brain tumors was 16% (95% CI 10-24%). The prevalence of delirium in patients with low-grade gliomas, high-grade gliomas, and brain metastases were 10%, 24%, and 43% respectively. Compared to the occipital lobe, the highest relative risk for delirium occurred for tumors in the limbic system (RR 5.01; 95% CI 1.88-16.35), then frontal (RR 3.01, CI 1.33, 7.89), and temporal (RR 2.94, CI 1.27-7.83) lobes. were more likely to have hypoactive (RR 5.20, 95% CI 3.74-7.44) or hyperactive delirium (RR 3.24, 95% CI 2.29-4.67) rather than mixed. Delirium was associated with an increased length of stay (4.62 days longer; 95% CI 3.23-6.01). There was large heterogeneity across studies.

Conclusions:
We confirmed the high prevalence of delirium in patients hospitalized with brain tumors. Notably, delirium rates seemed to reflect brain tumor location, grade, and origin, suggesting the potential importance of specific pathophysiologies. 
10.1212/WNL.0000000000210702
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