Delirium following traumatic brain injury in adolescents: Symptomatology and prediction of ability to return to school or employment 1‐year post‐injury

Abstract

BackgroundThere is a limited evidence‐base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, nor the degree to which delirium impacts adolescents’ ability to return to school or work.ObjectiveTo describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability one year post‐injury was also examined.DesignExploratory secondary analysis of prospectively collected data.SettingFree‐standing rehabilitation hospital.PatientsSeverely injured TBI Model Systems neurorehabilitation admissions (n=243; Median Glasgow Coma Scale=7). The sample was divided into three age groups (adolescents, 16‐21 years, n=63; adults 22‐49 years, n=133; older adults ≥50 years, n=47).InterventionsNot applicable.MeasuresWe assessed patients using DSM‐IV diagnostic criteria and the Delirium Rating Scale‐Revised 98 (DRS‐R‐98). The employability item from the Disability Rating Scale was the primary one‐year outcome.ResultsMost items on the DRS‐R‐98 differentiated delirious from non‐delirious adolescents. Only “delusions” differed among age groups. Among adolescents, delirium status one month post‐TBI provided acceptable classification of employability prediction one year later (AUC .797; 95% CI: 0.69‐0.91, p<.001). Delirium symptom severity (AUC.857, 95% CI 0.68–1.03, SE.0904, p <.001) and days of post‐traumatic amnesia (AUC.848, 95% CI 0.68–1.01, SE.0843, p <.001) provided excellent prediction of outcomes for TBI patients in delirium.ConclusionsDelirium symptomatology was similar among age groups and useful in differentiating the delirium status within the adolescent TBI group. Delirium and symptom severity at one month post‐TBI were highly predictive of poor outcomes. Findings from this study support the utility of DRS‐R‐98 at one month post‐injury to inform treatment and planning.This article is protected by copyright. All rights reserved.