Delirium in Trauma Patients: Prevalence and Predictors.
BACKGROUND
Delirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit.


OBJECTIVE
To determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center.


METHODS
Trauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit. Exclusion criteria included documented brain injury, history of psychosis or cognitive impairment, not speaking English, and hearing or vision loss.


RESULTS
Of the 215 study patients, 24% were positive for delirium; 36% of patients in the intensive care unit and 11% of patients in the intermediate care unit. Delirium-positive patients were older (mean age, 53.4 years) than patients who were not (mean age, 44 years; P = .004). Although mechanical ventilation (odds ratio, 4.73, P = .004) was the strongest independent risk factor for delirium, 12% of delirium-positive patients were not receiving mechanical ventilation. Other predictors of delirium were use of antipsychotic medications, higher scores on the Acute Physiology and Chronic Health Evaluation III, and lower scores on the Richmond Agitation-Sedation Scale.


CONCLUSIONS
Patients in both the intermediate and intensive care units, whether mechanical ventilation was used or not, were positive for delirium. Delirium prevention protocols may benefit trauma patients regardless of their inpatient location.
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland. vonrueden@verizon.net.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland. vonrueden@verizon.net.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center. vonrueden@verizon.net.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center vonrueden@verizon.net.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center. vonrueden@verizon.net.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute vonrueden@verizon.net.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea. vonrueden@verizon.net.
Kathryn T
KT
Von Rueden
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Breighanna
B
Wallizer
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Paul
P
Thurman
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Karen
K
McQuillan
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Tiffany
T
Andrews
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Jennifer
J
Merenda
Kathryn T. Von Rueden is an associate professor in the trauma, critical care, emergency department adult-gerontology ACNP/CNS/DNP program, University of Maryland School of Nursing, Baltimore, Maryland.|Breighanna Wallizer is an acute care nurse practitioner in the orthopedics department, R Adams Cowley Shock Trauma Center University of Maryland Medical Center, Baltimore, Maryland.|Paul Thurman is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Karen McQuillan is a clinical nurse specialist at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.|Tiffany Andrews is adjunct faculty at the University of Maryland School of Nursing and a senior nurse practitioner in the emergency department, University of Maryland Medical Center.|Jennifer Merenda is the director of clinical operations, The University of Maryland Rehabilitation and Orthopaedic Institute.|Heesook Son is an assistant professor in Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Heesook
H
Son
D018806:APACHE; D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012121:Respiration, Artificial / Q000009:adverse effects*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014505:Urban Population; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
D011619:Psychotropic Drugs