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Background Impact of mediating factors on the relationship between socioeconomic disadvantage and outcomes among patients with acute ischemic stroke has not been well characterized. Methods Data on patients with acute ischemic stroke were extracted from electronic medical records, and 90‐day modified Rankin scale (mRS) scores were collected as part of a prospective stroke registry. Exact patient addresses were geocoded and characterized using Area Deprivation Index (ADI) ranks. The 90‐day modified Rankin scale scores ≥3 were categorized as poor outcomes. Logistic regression models (adjusted for treatment with intravenous tissue plasminogen activator or intraarterial therapy, sociodemographics, and comorbidities) were fitted to compute adjusted odds ratios (aORs) and 95% CIs for total effect of high ADI on poor outcomes. In‐hospital mortality (versus survived) and unfavorable (versus favorable) discharge disposition were also evaluated as outcomes. Structural equation modeling was used to report the average causal mediation effects of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and treatment (intravenous tissue plasminogen activator or intraarterial therapy). Results Between May 2016 and December 2021, 13 641 patients with acute ischemic stroke (median age, 69 years; 50.1% women) were included. Among 3002 patients with functional outcomes data, a high ADI was significantly associated with poor 90‐day modified Rankin scale score (aOR, 1.16 [95% CI, 1.04–1.29]). Patients in higher ADI neighborhoods had increased odds of having higher NIHSS scores (aOR, 1.19 [95% CI, 1.07–1.32]). Likewise, a higher NIHSS score was associated with poor 90‐day modified Rankin scale score (aOR, 9.34 [95% CI, 7.64–11.5]). The effect of neighborhood disadvantage on poor 90‐day modified Rankin scale score was 59% mediated by NIHSS score (average causal mediation effects: P

Background Delirium experienced poststroke is known to be associated with poor prognosis; however, the outcomes and functional consequences among patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (intravenous tissue plasminogen activator) or intraarterial therapy are not well characterized. Methods Using data from 7 stroke centers with standardized delirium screening protocols, delirium was determined by a positive modified “Arousal, Attention, Abbreviated Mental‐Test, Acute Change Test” or Confusion Assessment Method for the Intensive Care Unit screen including diagnosis codes. Multivariable models were fit to estimate likelihoods of in‐hospital mortality, unfavorable discharge disposition, and longer length of stay among delirious patients with AIS, reported as adjusted odds ratios (aORs), adjusted incident rate ratios, and 95% CIs. A subset of patients with AIS with 90‐day modified Rankin scale (mRS) including those receiving intravenous tissue plasminogen activator or intraarterial therapy were analyzed for shifts in mRS scores associated with delirium, via ordinal logistic regression models. Results Between May 2016 and June 2021, AIS was the primary diagnosis in 12 409 hospitalization encounters representing 10 874 unique patients. Delirium was documented in 41.6% of AIS encounters, compared with 26.5% of age and mild cognitive impairment– or dementia‐matched non‐AIS encounters. Delirious (versus nondelirious) patients with AIS were older (median: 75 years versus 65 years), more frequently women (53.3% versus 48.7%), with a higher comorbidity burden (median Charlson Comorbidity Index: 7 versus 5). Delirious patients with AIS had higher odds of in‐hospital mortality (aOR, 2.66; [95% CI, 1.62–4.49]), unfavorable discharge disposition (aOR, 3.68; [95% CI, 3.15–4.30]), and longer length of stay (adjusted incidence rate ratio, 1.67; CI, 1.61–1.73). In the cohort of 2784 patients with treated and untreated AIS with 90‐day mRS, adjusted models indicated lower mRS (aOR, 0.54; CI, 0.46–0.63) associated with treatment, and higher mRS for delirious patients with AIS (aOR, 3.09; CI, 2.58–3.71). Among the subcohort of 948 patients with treated AIS, delirium remained significantly associated with higher mRS (aOR, 2.82; CI, 2.08–3.83). Conclusion Delirium is common among patients with AIS including those receiving intravenous tissue plasminogen activator or undergoing intraarterial therapy and prognosticates poor in‐hospital and 90‐day outcomes. Active screening and management of delirium may lead to improved stroke outcomes.