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

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Abstract

Background

Delirium remains understudied after traumatic brain injury (TBI). We sought to identify independent predictors of delirium among intensive care unit (ICU) patients with TBI.

Methods

This single-center retrospective cohort study evaluated adult patients with TBI requiring ICU admission. Outcomes included delirium days within the first 14 days, as assessed by the Confusion Assessment Method-ICU (CAM-ICU). Models were adjusted for age, sex, insurance, Marshall head computed tomography classification, presence of subarachnoid hemorrhage (SAH), Injury Severity Score (ISS), need for cardiopulmonary resuscitation, maximum admission Glasgow Coma motor score, glucose level, hemoglobin level, and pupil reactivity.

Results

Delirium prevalence was 60%, with a median duration of 4 days (interquartile range: 2–8) among ICU patients with TBI (n = 2,664). Older age, higher ISS, maximum motor score < 6, Marshall class II–IV, and SAH were associated with risk of increased delirium duration (all p < 0.001).

Conclusions

In this large cohort, ICU delirium after TBI affected three of five patients for a median duration of 4 days. Age, general injury severity, motor score, and features of intracranial hemorrhage were predictive of more TBI-associated delirium days. Given the high prevalence of ICU delirium after TBI and its impact on hospitalization, further work is needed to understand the impact of delirium and TBI on outcomes and to determine whether delirium risk can be minimized.

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Funding

This project was supported by the Vanderbilt Faculty Research Scholar Program. We used REDCap, a secure online database supported in part by the National Institutes of Health (UL1TR000445). LFS was supported by the Dr. and Mrs. G. Ashley Allen Research Grant. MRC was supported by the Vanderbilt Medical Scholars Program. MFN, DNH, ELR, and MBP, and have been supported by the National Institutes of Health (F32AG062045, R01GM120484, R01AG058639, I01RX002992, T32GM135094, T32CA10618315).

Author information

Authors and Affiliations

  1. Oxley College of Health Sciences, Communication Sciences, and Disorders, The University of Tulsa, Tulsa, OK, USA

    Laura D. Wilson

  2. Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA

    Amelia W. Maiga, Mina F. Nordness, Shayan Rakhit, Laney F. Smith, Erika L. Rivera, Madison R. Cook, Jennifer L. Thompson, Rameela Raman & Mayur B. Patel

  3. Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Amelia W. Maiga, Sarah Lombardo, Mina F. Nordness, Diane N. Haddad, Shayan Rakhit, Erika L. Rivera, Madison R. Cook & Mayur B. Patel

  4. Section of Acute Care Surgery, Division of General Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA

    Sarah Lombardo

  5. The Trauma Center at Penn, Philadelphia, PA, USA

    Diane N. Haddad

  6. Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA

    Laney F. Smith

  7. Meharry Medical College, Nashville, TN, USA

    Madison R. Cook

  8. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Jennifer L. Thompson & Rameela Raman

  9. Department of Surgery, Temple University Hospital, Philadelphia, PA, USA

    Madison R. Cook

  10. Devoted Health, Waltham, MA, USA

    Jennifer L. Thompson

  11. Geriatric Research Education and Clinical Center, Surgical Services, Tennessee Valley Healthcare System, Nashville, TN, USA

    Amelia W. Maiga & Mayur B. Patel

Authors
  1. Laura D. Wilson
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Contributions

MBP, LDW, JLT, and RR conceived the study, acquired the data, and created the analysis plan. LDW, AWM, SL, DNH, and MFN created an initial manuscript draft. All authors interpreted the data, critically revised the manuscript, and read and approved the final version of the manuscript.

Corresponding author

Correspondence to Mayur B. Patel.

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All authors declare that they have no conflicts of interest.

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This article adheres to ethical guidelines, has been institutional review board approved, and was deemed exempt from requiring consent given its retrospective nature.

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Wilson, L.D., Maiga, A.W., Lombardo, S. et al. Prevalence and Risk Factors for Intensive Care Unit Delirium After Traumatic Brain Injury: A Retrospective Cohort Study. Neurocrit Care 38, 752–760 (2023). https://doi.org/10.1007/s12028-022-01666-1

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  • DOI: https://doi.org/10.1007/s12028-022-01666-1

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