Delirium in Trauma Patients: Prevalence and Predictors

Rueden, Kathryn T. Von; Wallizer, Breighanna; Thurman, Paul; McQuillan, Karen; Andrews, Tiffany; Merenda, Jennifer; Son, Heesook

doi:10.4037/ccn2017373

Cited by 27 publications

(26 citation statements)

References 41 publications

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“…We found a 21.1% incidence of delirium in critically ill patients, which is consistent with Von Rueden's finding [15] of a 24% incidence of delirium after trauma but is lower than the rate after liver transplantation reported by Beckmann [16]. The APACHE II score system is used to evaluate the severity and prognosis of critically ill patients.…”

Section: Discussionsupporting

confidence: 90%

Development and validation of a predictive score for ICU delirium in critically ill patients

et al. 2021

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Background The incidence of delirium in intensive care unit (ICU) patients is high and associated with a poor prognosis. We validated the risk factors of delirium to identify relevant early and predictive clinical indicators and developed an optimized model. Methods In the derivation cohort, 223 patients were assigned to two groups (with or without delirium) based on the CAM-ICU results. Multivariate logistic regression analysis was conducted to identify independent risk predictors, and the accuracy of the predictors was then validated in a prospective cohort of 81 patients. Results A total of 304 patients were included: 223 in the derivation group and 81 in the validation group, 64(21.1%)developed delirium. The model consisted of six predictors assessed at ICU admission: history of hypertension (RR = 4.367; P = 0.020), hypoxaemia (RR = 3.382; P = 0.018), use of benzodiazepines (RR = 5.503; P = 0.013), deep sedation (RR = 3.339; P = 0.048), sepsis (RR = 3.480; P = 0.018) and mechanical ventilation (RR = 3.547; P = 0.037). The mathematical model predicted ICU delirium with an accuracy of 0.862 (P < 0.001) in the derivation cohort and 0.739 (P < 0.001) in the validation cohort. No significant difference was found between the predicted and observed cases of ICU delirium in the validation cohort (P > 0.05). Conclusions Patients’ risk of delirium can be predicted at admission using the early prediction score, allowing the implementation of early preventive interventions aimed to reduce the incidence and severity of ICU delirium.

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Section: Discussionsupporting

confidence: 90%

Development and validation of a predictive score for ICU delirium in critically ill patients

et al. 2021

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“…Multivariate regression analysis of risk factors associated with delirium.Von Rueden et al[13] reported the incidence of delirium among patients admitted to the intermittent care unit, and the ICU. The of delirium prevalence (24%) was significantly associated with the use of mechanical ventilation, psychotropic medications, high Acute Physiology and Chronic Health Roh et al / Risk Factors of Delirium in Abdominal Trauma Patients of the ICU.…”

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confidence: 99%

The Incidence and Impact of Abdominal Surgery on Delirium in Abdominal Trauma Patients

Roh

Park

et al. 2020

J Acute Care Surg

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Purpose: The occurrence of trauma-related delirium following postoperative abdominal surgery is associated with a poor prognosis. The purpose of this study was to identify predictive risk factors for trauma-related delirium. Methods: Trauma patient data from a regional trauma center were retrospectively collected from August 2015 to December 2016. The primary inclusion criteria were patients diagnosed with traumarelated delirium following abdominal trauma surgery. Head trauma patients and those under 18 years of age were excluded from this study. A multivariate logistic regression analysis was performed to identify the risk factors associated with trauma-related delirium. Results: Of the 255 trauma patients who met the inclusion criteria, 32 (12.5%) were diagnosed with delirium. The mean values for the age of the patients, Injury Severity Score, Glasgow Coma Scale score, and length of intensive care unit stay were 52.1 ± 17.8 years, 16.9, 14, and 7.1 days, respectively. Among the measured parameters, age [odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01-1.06; p = 0.022)], sex (OR, 0.125; 0.03-0.55; p = 0.006), hemoglobin level (OR, 0.875; CI, 0.68-0.98; p = 0.03), length of stay in the intensive care unit (OR, 1.12; CI, 1.03-1.22; p = 0.01), and having an abdominal operation (OR, 2.92; CI, 1.10-7.23; p = 0.011) showed strong correlations with trauma-related delirium Conclusion: This study showed that abdominal surgery was strongly associated with delirium in patients with traumatic abdominal injury. Thus, changes in consciousness should be carefully monitored following surgery.

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“…It is likely that severe hypoxemia leads to cognitive dysfunction including delirium, but there is no clear evidence for chronic or acute lung disease to cause delirium (Grant et al, 1980). Even though there was no difference in oxygenation between delirious and non-delirious patients, delirium occurs more often after mechanical ventilation (Von Rueden et al, 2017) but was not associated with chronic lung disease (Takeuchi et al, 2005). The relationship between abdominal/thoracic injuries or operations and the occurrence of delirium in our patients has already been reported (Koster et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Assessing delirium with nursing care instruments: Evaluation of the cognitive and associated domains

et al. 2020

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Objective Nursing instruments have the potential for daily screening of delirium; however, they have not yet been evaluated. Therefore, after assessing the functional domains of the electronic Patient Assessment — Acute Care (ePA-AC), this study evaluates the cognitive and associated domains. Methods In this prospective cohort study in the intensive care unit, 277 patients were assessed and 118 patients were delirious. The impacts of delirium on the cognitive domains, consciousness and cognition, communication and interaction, in addition to respiration, pain, and wounds were determined with simple logistic regressions and their respective odds ratios (ORs). Results Delirium was associated with substantial impairment throughout the evaluated domains. Delirious patients were somnolent (OR 6), their orientation (OR 8.2–10.6) and ability to acquire knowledge (OR 5.5–11.6) were substantially impaired, they lost the competence to manage daily routines (OR 8.2–22.4), and their attention was compromised (OR 12.8). In addition, these patients received psychotropics (OR 3.8), were visually impaired (OR 1.8), unable to communicate their needs (OR 5.6–7.6), displayed reduced self-initiated activities (OR 6.5–6.9) and challenging behaviors (OR 6.2), as well as sleep–wake disturbances (OR 2.2–5), Furthermore, delirium was associated with mechanical ventilation, abdominal/thoracic injuries or operations (OR 4.2–4.4), and sensory perception impairment (OR 3.9–5.8). Significance of results Delirium caused substantial impairment in cognitive and associated domains. In addition to the previously described functional impairments, these findings will aid the implementation of nursing instruments in delirium screening.

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Delirium in Trauma Patients: Prevalence and Predictors

Cited by 27 publications

References 41 publications

Development and validation of a predictive score for ICU delirium in critically ill patients

Development and validation of a predictive score for ICU delirium in critically ill patients

The Incidence and Impact of Abdominal Surgery on Delirium in Abdominal Trauma Patients

Assessing delirium with nursing care instruments: Evaluation of the cognitive and associated domains

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