ABSTRACT NUMBER: ESOC2026A2276 DELIRIUM SCREENING AT THE STROKE UNIT: ONE-YEAR RESULTS

Abstract Background and aims Delirium is a common complication of stroke. Early identification of post-stroke delirium is essential for guiding targeted interventions. Without structured assessments and serial observations, delirium—particularly the hypoactive subtype—may go undetected. The 4 ‘A’s Test (4AT) is a validated screening tool with high sensitivity and specificity in acute stroke patients. A score ≥ 4 indicates a possible delirium. When used alongside the Richmond Agitation and Sedation Scale (RASS), the specific delirium subtype can be determined. As part of a quality improvement initiative, routine delirium screening using 4AT and RASS was implemented for all patients hospitalized at the Stroke Unit at UZ Brussel. This screening was performed twice daily during stay at Stroke Unit (usually 48hours) and conducted by stroke nurses. Methods Prior to the implementation on 27/05/2024, scales were added to the electronic medical file and nurses underwent individual training in 4AT and RASS. From 27/05/2024 to 30/05/2025, data were collected from the electronic medical records on the number of delirium screenings per patient, and test scores. Results From 27/05/2024 to 30/05/2025, 611 patients were hospitalized at the Stroke Unit of UZ Brussel. Age, gender, NIHSS at admission and diagnosis at discharge are presented in Table 1. On average, four 4AT assessments were performed per patient. Delirium was observed in 27% of patients. Subgroups are described in Table 1. Conclusions 4AT is feasible screening tool in patients hospitalized at the Stroke Unit, applicable across various stroke subtypes and mimics. Overall delirium rate was 27%, with highest prevalence in hemorrhagic strokes. Conflict of interest None Figure 1 - belongs to Results