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Neurological Examination Frequency and Time-to-Delirium After Traumatic Brain Injury.

Silky Chotai1, Jeffrey W Chen2, Robert Turer3

  • 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA.

Neurosurgery
|June 16, 2023
PubMed
Summary
This summary is machine-generated.

Frequent neurological exams in traumatic brain injury (TBI) patients increase delirium risk. Reducing neuro-checks may prevent delirium and improve patient outcomes.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Trauma Surgery

Background:

  • Frequent neurological examinations in traumatic brain injury (TBI) patients disrupt sleep-wake cycles.
  • This disruption may contribute to the development of delirium in TBI patients.

Purpose of the Study:

  • To evaluate the risk of delirium among TBI patients based on neuro-check frequencies.
  • To determine if the frequency of neurological examinations impacts delirium incidence and onset.

Main Methods:

  • Retrospective study of 1552 TBI patients at a level I trauma center (2018-2019).
  • Compared delirium risk in patients receiving hourly (Q1), every 2 hours (Q2), or every 4 hours (Q4) neuro-checks.
  • Delirium onset defined by Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score.

Main Results:

  • 29.5% of TBI patients developed delirium; median time-to-delirium was 1.8 days.
  • Hourly neuro-checks (Q1) were associated with a significantly higher rate of delirium (P < .001).
  • Q2 and Q4 neuro-checks were protective against delirium (HR: 0.439 and 0.48, respectively) compared to Q1.

Conclusions:

  • More frequent neurological examinations in TBI patients are linked to a higher risk of delirium.
  • Less frequent neuro-checks (Q2, Q4) are associated with a reduced risk of delirium development.
  • Optimizing neuro-check frequency may be a strategy to mitigate delirium in TBI patients.