Delirium after major trauma critical care and the association with recovery at 12 months.

Abstract

Purpose: Delirium is associated with poor outcomes in general critical care populations, but the effects on recovery in major trauma patients are less clear. This study aimed to characterise critical care trauma patients with self-reported delirium and explore the relationship with recovery at 12 months post-injury.

Methods: A prospective multi-site observational study of patients admitted to four Major Trauma Centre critical care units. Follow-up questionnaires assessed quality of life and recovery using the EQ Visual Analogue Scale (EQ VAS), European Quality-of-Life Five Dimensions (EQ-5D-5L) and the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 surveys. Post-discharge support was recorded together with 'difficulties in the 30 days leading up to follow-up' (WHODAS).

Results: Of the 285 severely injured adult patients who completed the follow-up questionnaires, 180 (63%) reported delirium in hospital. Traumatic brain injury was higher in the delirium group (40% vs 28%, p = 0.05). Overall health score was worse at 12 months for those reporting delirium (EQ-5D VAS: delirium 67.5 vs no delirium 75, p = 0.01). Patients with delirium also reported more days where difficulties were present (delirium: 22 days vs no delirium: 17 days, p < 0.01) and days of reduced activities (delirium: 7 days vs no delirium: 4 days, p = 0.01). Those with in hospital delirium reported more psychological and cognitive problems via both EQ-5D-5L and WHODAS 2.0. Despite this, fewer than half [n = 79, (44%)] had received any form of psychological support as part of their treatment or recovery.

Conclusions: Severely injured trauma critical care patients with self-reported in hospital delirium experience worse quality of life at 12 months post-injury. Psychological problems were greater after in-hospital delirium and longer-term support for these patients appears to be limited.