Delirium Bibliography

Reference Information

Title

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

Authors

Fonseca, R. A. Canas, M. Diaz, L. Aldana, J. A. Afzal, H. De Filippis, A. Del Toro, D. Day, A. McCarthy, J. Stansfield, K. Bochicchio, G. V. Niziolek, G. Kranker, L. M. Rosengart, M. R. Hoofnagle, M. Leonard, J.

Year

2024

Journal

J Trauma Acute Care Surg

Abstract

BACKGROUND: Serial neurological examinations (NEs) are routinely recommended in the intensive care unit (ICU) within the first 24 hours following a traumatic brain injury (TBI). There are currently no widely accepted guidelines for the frequency of NEs. Disruptions to the sleep-wake cycles increase the delirium rate. We aimed to evaluate whether there is a correlation between prolonged hourly (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: A retrospective analysis of patients with mild/moderate TBI, admitted to the ICU with serial NEs, was performed. Cohorts were stratified by the duration of exposure to Q1-NE, into prolonged (≥24 hours) and nonprolonged (<24 hours). Our primary outcomes of interest were delirium, evaluated using the Confusion Assessment Method; radiological progression from baseline images; neurological deterioration (focal neurological deficit, abnormal pupillary examination, or Glasgow Coma Scale score 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 Injury Severity Score with similar head Abbreviated Injury Score, significantly higher delirium rate (59% vs. 35%, p < 0.001), and a longer hospital/ICU length of stay when compared with the nonprolonged Q1-NE group. No neurosurgical interventions were found to be performed emergently as a result of findings on NEs. 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. CONCLUSION: Geriatric patients with mild/moderate TBI exposed to Q1-NE for periods longer than 24 hours had nearly a threefold increase in ICU delirium rate. One 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 NEs. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

PMID

PMID: 38509046

PMCID: PMC11199100

NIHMSID: NIHMS1969133

Keywords

Humans
*Delirium/diagnosis/etiology/epidemiology
Male
*Brain Injuries, Traumatic/complications/diagnosis
Female
Retrospective Studies
Aged
*Neurologic Examination/methods
*Glasgow Coma Scale
*Intensive Care Units/statistics & numerical data
Time Factors
Aged, 80 and over
Middle Aged
Risk Factors

Page(s)

Volume

Issue