title: The Fog of War: Delirium Prevalence in a Combat Intensive Care Unit.
abstract: BACKGROUND
  Delirium is a fluctuating disturbance in consciousness associated with increased mortality. Injured warriors represent a unique unstudied population. We hypothesized delirium is common because of high injury severity scores and multidrug sedation regimens.
  
  
  METHODS
  Mandatory delirium screening using the confusion assessment method (CAM) was initiated at Craig Joint Theater Hospital in Bagram, Afghanistan. Data were collected in July to August 2012 from the first 50 English-speaking trauma patients with CAM for the Intensive Care Unit (ICU) scores.
  
  
  RESULTS
  Patients were male with mean age of 27.8 years; 88% of them were U.S. military personnel. Injury mechanisms were blast (68%) and gunshot (26%). Mean injury severity score was 20. Average ICU length of stay was 2.3 days; 64% were ventilated (for mean 1.2 days). Average time from arrival to CAM assessment was 7 hours, and 26 hours from the time of injury. Of patients, 44% were delirious, 36% at first CAM assessment. Fentanyl (62%) and ketamine (16%) were used for pain control (62%) and propofol for sedation (52%). There was no relationship between delirium and mechanism (p = 0.5) or ketamine on first ICU day (p = 0.2262). Delirium increased with vent days (p < .0001) and was associated with admission and mechanical ventilation (p = 0.0025).
  
  
  CONCLUSIONS
  This study demonstrates a high rate of delirium in this unique population.
authors.affiliation: 99th Medical Group, Mike O'Callaghan Federal Medical Center, 4700 N Las Vegas Boulevard, Nellis AFB, NV 89191.
authors.forename: Nichole K
authors.initials: NK
authors.lastname: Ingalls
authors.affiliation: 99th Medical Group, Mike O'Callaghan Federal Medical Center, 4700 N Las Vegas Boulevard, Nellis AFB, NV 89191.
authors.forename: Bracken
authors.initials: B
authors.lastname: Armstrong
authors.affiliation: 99th Medical Group, Mike O'Callaghan Federal Medical Center, 4700 N Las Vegas Boulevard, Nellis AFB, NV 89191.
authors.forename: Marisa
authors.initials: M
authors.lastname: Hester
authors.affiliation: Defense Medical Research and Development Program, 504 Scott Street, Fort Detrick, MD 21702.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Hatzfeld
authors.affiliation: Division of Trauma and Critical Care, University of Cincinnati College of Medicine, 231 Albert B Sabin Way, P.O. Box 670558, Cincinnati, OH 45267.
authors.forename: Bryce R H
authors.initials: BR
authors.lastname: Robinson
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, UT Memorial Hermann Hospital, 6400 Fannin Street, Suite 2850, Houston, TX 77030.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Fortuna
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001753:Blast Injuries / Q000601:surgery / Q000628:therapy*; D003422:Critical Care; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008889:Military Personnel; D009730:Nursing Assessment; D015995:Prevalence; D012121:Respiration, Artificial / Q000009:adverse effects*; D014481:United States; D000067398:War-Related Injuries / Q000601:surgery / Q000628:therapy*; D055815:Young Adult