Delirium after a traumatic brain injury: predictors and symptom patterns

Abstract

BackgroundDelirium 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.MethodsTBI 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).ResultsThe 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.ConclusionAlmost 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.

Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts

“…Agitation and delirium can occur in up to 50% of patients with mild to moderate TBI in the first 4 days after the trauma. 25 Posttraumatic delirium is thought to be caused by neuro-inflammation, neurotransmitter imbalance, and structural brain damage. 26 Although the incidence of delirium is high in TBI patients, previous studies have not demonstrated that TBI is associated with a longer duration of delirium.…”

Delirium incidence and risk factors in adult critically ill patients in Saudi Arabia

“…[ 38 ] Another study investigated traumatic brain injury patients in the neurosurgical ward, concluded that those with low GCS score on admission in the emergency department were more likely to have delirium in the first 4 days after admission. [ 39 ]…”

Delirium Resulting From Traumatic Brain Injury as an Acute Risk Factor for Suicide: A Case Report and Review of the Literature

“…13 It is estimated that posttraumatic delirium may affect up to half of patients with mild or moderate head injuries within the first 4 days following the trauma. 14 The association between posttraumatic delirium and suicide is not known; however, the results of a recent metaanalysis 5 indicate a moderate association between psychomotor agitation (which is a component of delirium) and the risk of suicide. However, further research will be necessary in order to examine the short-term risk of suicide in this patient population, given that posttraumatic delirium is not manifested in a homogeneous manner in the various clinical populations.…”