Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management

Williams, Elliot; Estime, Stephen; Kuza, Catherine M.

doi:10.1097/aco.0000000000001233

Cited by 5 publications

(9 citation statements)

References 48 publications

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“…In our cohort, prolonged Q1-NE was associated with a higher rate of ICU delirium (59%); this raises a concern about whether our current practices need revising. Delirium rates reported by Williams et al 15 support our findings and add relevance to sys-tematic reviews highlighting the need for ongoing investigation of delirium in neurologically ill patients. 24 The chronological association between prolonged Q1-NE exposure and earlier onset of delirium demonstrates a potential contribution of frequent NEs to the exacerbation of posttraumatic mental status changes due to sleep disruption.…”

Section: Discussionsupporting

confidence: 90%

“…Most patients presented after a fall (90.8%) with median ISS of 14 (10)(11)(12)(13)(14)(15)(16)(17) and head AIS of 3 (IQR, 2-4). Based on our hospital trauma leveling criteria, a minority of patient were trauma activations, Level 1 (8.2%) and Level 2 (33%).…”

Section: Demographics and Injury Characteristicsmentioning

confidence: 99%

“…13 One potential is the harm of delirium, which is directly associated with increased LOS and worsened recovery in ICU patients. [14][15][16] In addition, the sleep deprivation resulting from extended periods of intensive nursing care and monitoring may exacerbate even further this situation. 13,[17][18][19][20] This study aimed to evaluate whether there is a correlation between prolonged intervals of Q1-NE and development of delirium in geriatric trauma patients with mild or moderate TBI.…”

mentioning

confidence: 99%

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Prolonged hourly neurological examinations are associated with increased delirium and no discernible benefit in mild/moderate geriatric traumatic brain injury

Fonseca,

Canas,

Diaz

et al. 2024

J Trauma Acute Care Surg

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Background Serial neurologic examinations (NE) are routinely recommended in the ICU within the first 24 hours following a TBI. There are currently no widely accepted guidelines for the frequency of NE. Disruptions to the sleep-wake cycles increase the delirium rate. We aimed to evaluate whether there is a correlation between prolonged Q1-NE and development of delirium and to determine if this practice reduces the likelihood of missing the detection of a process requiring emergent intervention. Methods Retrospective analysis of patients with mild/moderate TBI, admitted to the ICU with serial-NE. Cohorts were stratified by the duration of exposure to Q1-NE, into Prolonged(≥24 h) and Not Prolonged(<24 h). Our primary outcomes of interest was delirium, evaluated using the Confusion Assessment Method (CAM-ICU), radiological progression from baseline images, neurological deterioration (focal neurological deficit, abnormal pupillary exam, or GCS decrease >2), and neurosurgical procedures. Results A total of 522 patients were included. No significant differences were found in demographics. Patients in the Prolonged Q1-NE group (26.1%) had higher ISS with similar AIS Head, and significantly higher delirium rate [59% vs 35%, p < .001], and a longer Hospital/ICU length of stay when compared to the Not Prolonged Q1-NE group. No neurosurgical interventions were found to be performed emergently as a result of findings on NE. Multivariate analysis demonstrated that Prolonged Q1-NE was the only independent risk factor associated with a 2.5-fold increase in delirium rate. The Number Needed to Harm for prolonged Q1-NE was 4. Conclusions Geriatric patients with mild/moderate TBI exposed to Q1-NE for periods longer than 24 h had nearly a 3-fold increase in ICU-Delirium rate. One out of five patients exposed to prolonged Q1-NE is harmed by the development of delirium. No patients were found to directly benefit as a result of more frequent neurological examinations.

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Section: Discussionsupporting

confidence: 90%

Section: Demographics and Injury Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

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Prolonged hourly neurological examinations are associated with increased delirium and no discernible benefit in mild/moderate geriatric traumatic brain injury

Fonseca,

Canas,

Diaz

et al. 2024

J Trauma Acute Care Surg

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“…When pharmacologic strategies are needed, antipsychotic medications (APMs) are commonly prescribed, although their efficacy remains uncertain [17]. Some studies have suggested that APMs may be effective in reducing the duration and severity of delirium symptoms, while others have found no significant benefit [18,19]. The American Geriatrics Society guidelines for the management of delirium recommend the use of antipsychotic medications for patients with severe agitation or distress, but not for the routine treatment of delirium [20].…”

Section: Introductionmentioning

confidence: 99%

Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused

Martinez,

Tee,

Poulter

et al. 2023

JCM

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Background: Delirium is difficult to measure in the Intensive Care Unit (ICU). It is possible that by considering the rate of screening, incidence, and rate of treatment with antipsychotic medications (APMs) for suspected delirium, a clearer picture can emerge. Methods: A retrospective, observational study was conducted at two ICUs in Australia, between April and June of 2020. All adult ICU patients were screened; those who spoke English and did not have previous neurocognitive pathology or intracranial pathology were included in the analysis. Data were collected from the hospitals’ electronic medical records. The primary outcome was incidence of delirium based on the use of the Confusion Assessment Method for ICU (CAM-ICU). Secondary outcomes included measures of screening for delirium, treatment of suspected delirium with APMs, and identifying clinical factors associated with both delirium and the use of APMs. Results: From 736 patients that were screened, 665 were included in the analysis. The incidence of delirium was 11.3% (75/665); on average, the Richmond Agitation and Sedation Scale (RASS) was performed every 2.9 h and CAM-ICU every 40 h. RASS was not performed in 8.4% (56/665) of patients and CAM-ICU was not performed in 40.6% (270/665) of patients. A total of 17% (113/665) of patients were prescribed an APM, with quetiapine being the most used. ICU length of stay (LOS), APACHE-III score, and the use of alpha-2 agonists were associated with the presence of delirium, while ICU LOS, the use of alpha-2 agonists, and the presence of delirium were associated with patients receiving APMs. Conclusions: The incidence of delirium was lower than previously reported, at 11.3%. The rate of screening for delirium was low, while the use of APMs for delirium was higher than the incidence of delirium. It is possible that the true incidence is higher than what was measured. Critical prospective assessment is required to optimize APM indications in the ICU.

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“…Delirium is an acute, reversible, widespread cognitive disorder psychotic syndrome characterized by fluctuating disorders of consciousness, inattention, disorganized thinking, or changes in level of consciousness. [ 1 , 2 ] Patients receiving mechanical ventilatory support in the Intensive Care Unit (ICU) are at high risk of delirium. [ 3 ] Delirium can be diagnosed when certain psychiatric symptoms are present without abnormal central nervous system function and organic comorbidities.…”

Section: Introductionmentioning

confidence: 99%

The effect of music therapy on delirium in patients receiving mechanical ventilatory support in the Intensive Care Unit: A protocol for systematic review and meta-analysis

Zhou

Qi³

et al. 2023

Medicine

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Background: Delirium is a very common sick syndrome in patients receiving mechanical ventilatory support in the Intensive Care Unit (ICU). Music therapy is a promising non-pharmacological intervention. However, its effect on the duration, incidence and severity of delirium is unknown. So we will perform a systematic review and meta-analysis to evaluate the effect of music therapy on delirium in patients receiving mechanical ventilatory support in the ICU. Methods: This systematic review was registered in the PROSPERO. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the systematic review protocol. Searches of PubMed, EMbase, the Cochrane library, CBM, CNKI and Wanfang databases will be conducted through computer to collect randomized controlled trials (RCTs) on the effects of music therapy on delirium in patients receiving mechanical ventilatory support in the ICU. The search time will be all from database establishment to April 2023. Two evaluators will independently screen the literature, extract information and evaluate the risk of bias of included studies, then data analysis will be performed using Stata 14.0 software. Results: The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal. Conclusion: This study will provide evidence-based medical evidence for music therapy to control delirium in patients receiving mechanical ventilatory support in the ICU.

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Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management

Cited by 5 publications

References 48 publications

Prolonged hourly neurological examinations are associated with increased delirium and no discernible benefit in mild/moderate geriatric traumatic brain injury

Prolonged hourly neurological examinations are associated with increased delirium and no discernible benefit in mild/moderate geriatric traumatic brain injury

Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused

The effect of music therapy on delirium in patients receiving mechanical ventilatory support in the Intensive Care Unit: A protocol for systematic review and meta-analysis

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