title: Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage.
abstract: OBJECTIVE
  To determine whether delirium during the hospital stay predicted health-related quality of life (HRQOL) at 1 year after injury in trauma intensive care unit (ICU) survivors without intracranial hemorrhage, and to examine the association between depressive and posttraumatic stress disorder (PTSD) symptoms and each of the HRQOL domains at 1-year follow-up.
  
  
  METHODS
  Prognostic cohort with a 1-year follow-up.
  
  
  METHODS
  Level 1 trauma ICU.
  
  
  METHODS
  Adult patients without intracranial hemorrhage (N=173) admitted to a level 1 trauma ICU.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  HRQOL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey at 1 year after traumatic injury.
  
  
  RESULTS
  Average delirium duration ± SD was .51±1.1 days. Hierarchical multivariable linear regression analyses did not find a statistical relationship between delirium and HRQOL at 1-year follow-up. However, increased levels of depressive symptoms at 1 year were statistically associated with poorer functioning in all physical and mental health HRQOL domains, whereas PTSD at 1 year was statistically associated with all HRQOL domains except role-physical (P<.05).
  
  
  CONCLUSIONS
  There was no statistical association between delirium during the hospital stay and HRQOL at 1 year, which may be due to the short time spent in delirium by our study population. Depressive symptoms demonstrated a stronger relationship with mental and physical HRQOL domains at 1 year than PTSD, indicating their own unique pathway after trauma. Findings lend support for the separate assessment and management of depression and PTSD. Additional research on the duration and subtypes of delirium is needed within the trauma ICU population, as the effects are not widely known.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Nashville, TN.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Abraham
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Nashville, TN.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: Department of Biostatistics, Vanderbilt University, School of Medicine, Nashville, TN.
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
authors.affiliation: Division of Allergy/Pulmonary/Critical Care Medicine, Center for Health Services Research, Vanderbilt University, School of Medicine, Nashville, TN.
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.affiliation: Division of Allergy/Pulmonary/Critical Care Medicine, Center for Health Services Research, Vanderbilt University, School of Medicine, Nashville, TN; Geriatric Research Education and Clinical Center for the Tennessee Valley Veteran's Affairs Healthcare System, Nashville, TN.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Nashville, TN. Electronic address: kristin.archer@vanderbilt.edu.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
mesh_terms: D000328:Adult; D003693:Delirium / Q000523:psychology*; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D013997:Time Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000523:psychology*
keywords: Delirium; Depression; Multiple trauma; Quality of life; Rehabilitation; Stress disorders, post-traumatic