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. 2017 Feb 14:13:459-465.
doi: 10.2147/NDT.S128138. eCollection 2017.

Delirium after a traumatic brain injury: predictors and symptom patterns

Jutaporn Maneewong  1 , Benchalak Maneeton  1 , Narong Maneeton  1 , Tanat Vaniyapong  2 , Patrinee Traisathit  3 , Natthanidnan Sricharoen  3 , Manit Srisurapanont  1
Affiliations

Delirium after a traumatic brain injury: predictors and symptom patterns

Jutaporn Maneewong et al. Neuropsychiatr Dis Treat. .

Abstract

Background: Delirium in traumatic brain injury (TBI) is common, may be predictable, and has a multifaceted symptom complex. This study aimed to examine: 1) the sum score of Glasgow Coma Scale (GCS) and if its component scores could predict delirium in TBI patients, and 2) the prominent symptoms and their courses over the first days after TBI.

Methods: TBI patients were recruited from neurosurgical ward inpatients. All participants were hospitalized within 24 hours after their TBI. Apart from the sum score of GCS, which was obtained at the emergency department (ED), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for delirium were applied daily. The severity of delirium symptoms was assessed daily using the Delirium Rating Scale - Revised-98 (DRS-R-98).

Results: The participants were 54 TBI patients with a mean GCS score of 12.7 (standard deviation [SD] =2.9). A total of 25 patients (46.3%) met the diagnosis of delirium and had a mean age of 36.7 years (SD =14.8). Compared with 29 non-delirious patients, 25 delirious patients had a significantly lower mean GCS score (P=0.04), especially a significantly lower verbal component score (P=0.03). Among 18 delirious patients, four symptoms of the DRS-R-98 cognitive domain (orientation, attention, long-term memory, and visuospatial ability) were moderate symptoms (score ≥2) at the first day of admission. After follow-up, three cognitive (orientation, attention, and visuospatial ability) and two noncognitive symptoms (lability of affect and motor agitation) rapidly resolved.

Conclusion: Almost half of patients with mild to moderate head injuries may develop delirium in the first 4 days after TBI. Those having a low GCS score, especially the verbal component score, at the ED were likely to have delirium in this period. Most cognitive domains of delirium described in the DRS-R-98 were prominent within the first 4 days of TBI with delirium. Three cognitive and two noncognitive symptoms of delirium decreased significantly.

Keywords: DRS-R-98; Delirium Rating Scale Revised-98; Glasgow Coma Scale score; brain injuries; cognitive symptoms; noncognitive symptoms; traumatic.

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Conflict of interest statement

Disclosure Benchalak Maneeton has been an advisory board member of Pfizer and received honoraria and/or travel reimbursement from Lundbeck, Servier, and Pfizer. Narong Maneeton has received travel reimbursement from Lundbeck and Pfizer. Manit Srisurapanont has been an advisory board member of Lundbeck, Novartis, and Servier and received speaker’s honoraria from Lundbeck and Servier and grant/research support from Lundbeck and Servier. Jutaporn Maneewong, Tanat Vaniyapong, Patrinee Traisathit, and Natthanidnan Sricharoen report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram for the study enrollment and completion of delirious patients. Abbreviations: TBI, traumatic brain injury; DRS-R-98, Delirium Rating Scale – Revised-98.
Figure 2
Figure 2
Mean domain scores of noncognitive and cognitive domains obtained from 18 TBI patients with delirium, from day 1 to day 4. Abbreviations: TBI, traumatic brain injury; DRS-R-98, Delirium Rating Scale – Revised-98.
See this image and copyright information in PMC

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