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. 2023 Jun;38(3):752-760.
doi: 10.1007/s12028-022-01666-1. Epub 2023 Jan 31.

Prevalence and Risk Factors for Intensive Care Unit Delirium After Traumatic Brain Injury: A Retrospective Cohort Study

Laura D Wilson  1 , Amelia W Maiga  2   3   4 , Sarah Lombardo  3   5 , Mina F Nordness  2   3 , Diane N Haddad  3   6 , Shayan Rakhit  2   3 , Laney F Smith  2   7 , Erika L Rivera  2   3 , Madison R Cook  2   3   8   9 , Jennifer L Thompson  2   10   11 , Rameela Raman  2   10 , Mayur B Patel  12   13   14
Affiliations

Prevalence and Risk Factors for Intensive Care Unit Delirium After Traumatic Brain Injury: A Retrospective Cohort Study

Laura D Wilson et al. Neurocrit Care. 2023 Jun.

Abstract

Background: Delirium remains understudied after traumatic brain injury (TBI). We sought to identify independent predictors of delirium among intensive care unit (ICU) patients with TBI.

Methods: This single-center retrospective cohort study evaluated adult patients with TBI requiring ICU admission. Outcomes included delirium days within the first 14 days, as assessed by the Confusion Assessment Method-ICU (CAM-ICU). Models were adjusted for age, sex, insurance, Marshall head computed tomography classification, presence of subarachnoid hemorrhage (SAH), Injury Severity Score (ISS), need for cardiopulmonary resuscitation, maximum admission Glasgow Coma motor score, glucose level, hemoglobin level, and pupil reactivity.

Results: Delirium prevalence was 60%, with a median duration of 4 days (interquartile range: 2-8) among ICU patients with TBI (n = 2,664). Older age, higher ISS, maximum motor score < 6, Marshall class II-IV, and SAH were associated with risk of increased delirium duration (all p < 0.001).

Conclusions: In this large cohort, ICU delirium after TBI affected three of five patients for a median duration of 4 days. Age, general injury severity, motor score, and features of intracranial hemorrhage were predictive of more TBI-associated delirium days. Given the high prevalence of ICU delirium after TBI and its impact on hospitalization, further work is needed to understand the impact of delirium and TBI on outcomes and to determine whether delirium risk can be minimized.

Keywords: Critical illness; Delirium; Mental status; Predictors; Traumatic brain injury.

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Conflict of interest statement

Conflicts of Interest

All authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Characteristics of analyzed cohorts. ICU, intensive care unit; TBI, traumatic brain injury; DCFD, delirium- and coma-free days
Figure 2.
Figure 2.
Possible transitions between brain states in the study population. ICU, intensive care unit
Figure 3.
Figure 3.
Number of patients in transitional brain states (coma, delirium, normal) per day up to hospital day 30. Transitions often occur daily as individual patients move in and out of delirium, coma, and normal brain states before reaching permanent states of death or discharge.
See this image and copyright information in PMC

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