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

Wilson, Linda; Maiga, Amelia W.; Lombardo, Sarah; Nordness, Mina F.; Haddad, Devin; Rakhit, Shayan; Smith, Laney F.; Cook, Madison R.; Thompson, Jennifer L.; Raman, Rameela; Patel, Mayur B.

doi:10.1007/s12028-022-01666-1

Cited by 5 publications

(7 citation statements)

References 33 publications

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“…Our numbers are higher (26.3% vs. 18.3%), as published by Kozak and colleagues in AIS patients not admitted to an ICU [26]. Our numbers are similar for IPH (32% vs. 27%) to those published by Naidech et al [27] and lower for TBI (20.4% vs. 60%) compared to those published by Wilson et al [3]. The prevalence of delirium in our study is lower than those reported in the medical intensive care unit [28].…”

Section: Delirium Incidencesupporting

confidence: 80%

“…(2) The associations between delirium and clinical care utilization, including mechanical ventilation, intracranial pressure monitoring, and ICU length of stay. (3) The associations between delirium and discharge outcomes, such as discharge disposition. We also examined several covariates to assess their potential associations with delirium and outcomes.…”

Section: Exposure Outcomes and Covariatesmentioning

confidence: 99%

“…The epidemiology of neurocritical care admissions has evolved over the years, with an increasing number of individuals suffering from acute brain injuries (ABI), such as acute ischemic stroke (AIS), non-traumatic intraparenchymal hemorrhage (IPH), non-traumatic subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI). Concurrently, delirium, an acute neuropsychiatric syndrome characterized by disturbances in consciousness and cognitive function, has gained prominence as a pivotal complication in these patients [3]. Understanding the prevalence and impact of delirium within this subset of neurocritical care admissions is essential for optimizing patient care and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Delirium and Its Associations with Critical Care Utilizations and Outcomes at the Time of Hospital Discharge in Patients with Acute Brain Injury

Raquer,

Fong,

Walters

et al. 2024

Medicina

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Background and Objectives: We analyzed delirium testing, delirium prevalence, critical care associations outcomes at the time of hospital discharge in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), non-traumatic subarachnoid hemorrhage (SAH), non-traumatic intraparenchymal hemorrhage (IPH), and traumatic brain injury (TBI) admitted to an intensive care unit. Materials and Methods: We examined the frequency of assessment for delirium using the Confusion Assessment Method for the intensive care unit. We assessed delirium testing frequency, associated factors, positive test outcomes, and their correlations with clinical care, including nonpharmacological interventions and pain, agitation, and distress management. Results: Amongst 11,322 patients with ABI, delirium was tested in 8220 (726%). Compared to patients 18–44 years of age, patients 65–79 years (aOR 0.79 [0.69, 0.90]), and those 80 years and older (aOR 0.58 [0.50, 0.68]) were less likely to undergo delirium testing. Compared to English-speaking patients, non-English-speaking patients (aOR 0.73 [0.64, 0.84]) were less likely to undergo delirium testing. Amongst 8220, 2217 (27.2%) tested positive for delirium. For every day in the ICU, the odds of testing positive for delirium increased by 1.11 [0.10, 0.12]. Delirium was highest in those 80 years and older (aOR 3.18 [2.59, 3.90]). Delirium was associated with critical care resource utilization and with significant odds of mortality (aOR 7.26 [6.07, 8.70] at the time of hospital discharge. Conclusions: In conclusion, we find that seven out of ten patients in the neurocritical care unit are tested for delirium, and approximately two out of every five patients test positive for delirium. We demonstrate disparities in delirium testing by age and preferred language, identified high-risk subgroups, and the association between delirium, critical care resource use, complications, discharge GCS, and disposition. Prioritizing equitable testing and diagnosis, especially for elderly and non-English-speaking patients, is crucial for delivering quality care to this vulnerable group.

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Section: Delirium Incidencesupporting

confidence: 80%

Section: Exposure Outcomes and Covariatesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delirium and Its Associations with Critical Care Utilizations and Outcomes at the Time of Hospital Discharge in Patients with Acute Brain Injury

Raquer,

Fong,

Walters

et al. 2024

Medicina

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“…Mild-to-moderate TBI patients who were admitted to the ICU were more likely to have cognitive impairment 3 months after TBI than those without an ICU admission, which may be linked with ICU-acquired delirium. A much higher incidence of delirium is detected in patients admitted to the ICU, which in TBI patients, can be as high as 60% (Wilson et al, 2023). Delirium is one of the important causes of long-term cognitive decline (Goldberg et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

New Insights into Brain Imaging Methods for Rehabilitation of Brain Diseases

2024

Frontiers Research Topics

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Frontiers is more than just an open access publisher of scholarly articles: it is a pioneering approach to the world of academia, radically improving the way scholarly research is managed. The grand vision of Frontiers is a world where all people have an equal opportunity to seek, share and generate knowledge. Frontiers provides immediate and permanent online open access to all its publications, but this alone is not enough to realize our grand goals. Frontiers journal seriesThe Frontiers journal series is a multi-tier and interdisciplinary set of openaccess, online journals, promising a paradigm shift from the current review, selection and dissemination processes in academic publishing. All Frontiers journals are driven by researchers for researchers; therefore, they constitute a service to the scholarly community. At the same time, the Frontiers journal series operates on a revolutionary invention, the tiered publishing system, initially addressing specific communities of scholars, and gradually climbing up to broader public understanding, thus serving the interests of the lay society, too. Dedication to qualityEach Frontiers article is a landmark of the highest quality, thanks to genuinely collaborative interactions between authors and review editors, who include some of the world's best academicians. Research must be certified by peers before entering a stream of knowledge that may eventually reach the public -and shape society; therefore, Frontiers only applies the most rigorous and unbiased reviews. Frontiers revolutionizes research publishing by freely delivering the most outstanding research, evaluated with no bias from both the academic and social point of view. By applying the most advanced information technologies, Frontiers is catapulting scholarly publishing into a new generation. What are Frontiers Research Topics?Frontiers Research Topics are very popular trademarks of the Frontiers journals series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area.

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“…Mild-to-moderate TBI patients who were admitted to the ICU were more likely to have cognitive impairment 3 months after TBI than those without an ICU admission, which may be linked with ICU-acquired delirium. A much higher incidence of delirium is detected in patients admitted to the ICU, which in TBI patients, can be as high as 60% (Wilson et al, 2023 ). Delirium is one of the important causes of long-term cognitive decline (Goldberg et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Utilization of clinical and radiological parameters to predict cognitive prognosis in patients with mild-to-moderate traumatic brain injury

Wang¹,

Hui²,

Wang³

et al. 2023

Front. Neurosci.

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BackgroundCognitive impairment is a common sequela following traumatic brain injury (TBI). This study aimed to identify risk factors for cognitive impairment after 3 and 12 months of TBI and to create nomograms to predict them.MethodsA total of 305 mild-to-moderate TBI patients admitted to the First Affiliated Hospital with Nanjing Medical University from January 2018 to January 2022 were retrospectively recruited. Risk factors for cognitive impairment after 3 and 12 months of TBI were identified by univariable and multivariable logistic regression analyses. Based on these factors, we created two nomograms to predict cognitive impairment after 3 and 12 months of TBI, the discrimination and calibration of which were validated by plotting the receiver operating characteristic (ROC) curve and calibration curve, respectively.ResultsCognitive impairment was detected in 125/305 and 52/305 mild-to-moderate TBI patients after 3 and 12 months of injury, respectively. Age, the Glasgow Coma Scale (GCS) score, >12 years of education, hyperlipidemia, temporal lobe contusion, traumatic subarachnoid hemorrhage (tSAH), very early rehabilitation (VER), and intensive care unit (ICU) admission were independent risk factors for cognitive impairment after 3 months of mild-to-moderate TBI. Meanwhile, age, GCS score, diabetes mellitus, tSAH, and surgical treatment were independent risk factors for cognitive impairment after 12 months of mild-to-moderate TBI. Two nomograms were created based on the risk factors identified using logistic regression analyses. The areas under the curve (AUCs) of the two nomograms to predict cognitive impairment after 3 and 12 months of mild-to-moderate TBI were 0.852 (95% CI [0.810, 0.895]) and 0.817 (95% CI [0.762, 0.873]), respectively.ConclusionTwo nomograms are created to predict cognitive impairment after 3 and 12 months of TBI. Age, GCS score, >12 years of education, hyperlipidemia, temporal lobe contusion, tSAH, VER, and ICU admission are independent risk factors for cognitive impairment after 3 months of TBI; meanwhile, age, the GCS scores, diabetes mellitus, tSAH, and surgical treatment are independent risk factors of cognitive impairment after 12 months of TBI. Two nomograms, based on both groups of factors, respectively, show strong discriminative abilities.

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

Cited by 5 publications

References 33 publications

Delirium and Its Associations with Critical Care Utilizations and Outcomes at the Time of Hospital Discharge in Patients with Acute Brain Injury

Delirium and Its Associations with Critical Care Utilizations and Outcomes at the Time of Hospital Discharge in Patients with Acute Brain Injury

New Insights into Brain Imaging Methods for Rehabilitation of Brain Diseases

Utilization of clinical and radiological parameters to predict cognitive prognosis in patients with mild-to-moderate traumatic brain injury

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