title: Prevention of delirium in trauma patients: are we giving thiamine prophylaxis a fair chance?
abstract: BACKGROUND
  Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophylaxis in severely injured patients.
  
  
  METHODS
  We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients' medical records and the Alberta Trauma Registry.
  
  
  RESULTS
  Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% of patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophylaxis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis.
  
  
  CONCLUSIONS
  Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, standard protocols for prophylaxis are essential.
authors.affiliation: The Regional Trauma Services and the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Christopher
authors.initials: C
authors.lastname: Blackmore
authors.affiliation: The Regional Trauma Services and the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Ouellet
authors.affiliation: The Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Daniel
authors.initials: D
authors.lastname: Niven
authors.affiliation: The Regional Trauma Services, Department of Surgery, and Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: The Regional Trauma Services and the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D003693:Delirium / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D003955:Diagnostic Tests, Routine; D000431:Ethanol / Q000097:blood; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013831:Thiamine / Q000627:therapeutic use*; D014803:Vitamin B Complex / Q000627:therapeutic use*; D014899:Wernicke Encephalopathy / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000097:blood / Q000209:etiology / Q000523:psychology*
chemical_list: D014803:Vitamin B Complex; D000431:Ethanol; D013831:Thiamine