Delirium in patients with acute brain injury. Delirium during neuro-intensive care, cognitive status and health-related quality of life one year after admission (2020)

Abstract

Background. Delirium is a common and harmful condition in patients with critical illness. For patients with acute brain injury (ABI), knowledge about delirium remains limited. The overall aim of this study was to investigate and describe delirium in patients with ABI during critical illness focusing on detection, prevention and long-term consequences.

Methods. We designed a prospective before-and-after intervention study in an academic neuro-ICU. A phase of standard care was followed by intervention phase. We assessed delirium with the Confusion Assessment Method for the intensive care unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) and compared these assessments against psychiatric evaluations. We conducted 1-year follow-ups testing cognitive status and QoL.

Results. A total of 94 patients were included. The CAM-ICU corresponded poorly with diagnostic criteria, whereas the ICDSC showed acceptable validity. Comparing the standard care group to the intervention group, time with delirium was 4 days vs. 3.5 days, respectively. Forty-seven ABI survivors participated in follow-ups. Severe cognitive impairment appeared in 40% of participants.

Conclusion. In patients with ABI we found delirium screening to be feasible but challenging. The intervention bundle did not reduce the duration of delirium. Also, delirium did not predict cognitive impairment or QoL.

Place of employment

PhD author

Laura Krone Larsen, Critical Care Nurse, Master in Clincal Nursing

Date and place of defense

20th February 2020, Department of Clinical Medicine, University of Copenhagen

Supervisors

Principal supervisor:
Ingrid Egerod, Professor
Department of Intensive Care, Centre for Cancer and Organ Diseases, Rigshospitalet,
University of Copenhagen, Denmark.

Primary co-supervisor:
Kirsten Møller, Professor
Department of Neuroanaesthesiology, the Neurosciences Centre, Rigshospitalet,
University of Copenhagen, Denmark.

Co-supervisor:
Marian Petersen, Assistant professor
Department of Surgery, University Hospital of Zealand, Køge, Denmark.

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