Delirium in Lower Limb Trauma: The Incidence and Risk Factors in a Prospective Observational Study

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Geriatric Medicine
• Neuroscience
• Critical Care Medicine

Background:

• Delirium is a significant complication in patients with musculoskeletal trauma, especially the elderly, leading to increased morbidity and mortality.
• The exact causes of delirium in this population are not fully understood, but several risk factors have been identified.
• This study focuses on adult patients undergoing lower limb trauma surgeries in a tertiary care setting.

Purpose of the Study:

• To estimate the incidence of delirium in adult patients undergoing lower limb trauma surgery.
• To identify specific risk factors associated with delirium development in this patient cohort.
• To provide insights for developing targeted interventions to reduce delirium incidence and improve patient outcomes.

Main Methods:

• A prospective observational study included 150 adult patients with lower limb trauma admitted for surgery between August 2021 and December 2022.
• Data collected included Mini-Mental State Examination scores, Injury Severity Scores, and potential risk factors.
• Delirium was assessed using Confusion Assessment Method (CAM) and CAM-Severity scores, with daily screening via the Nursing 4-Abbreviated Trauma score.

Main Results:

• A 10% incidence of delirium was observed in the study population.
• Patients who developed delirium were significantly older (median age 79 vs. 46 years) and had longer hospital stays (13 vs. 8 days).
• Significant risk factors for delirium included female gender, delayed surgery, hyponatremia, hypoproteinaemia, increased injury severity, midazolam use, multiple blood transfusions, and high postoperative pain.

Conclusions:

• The study provides valuable data on delirium incidence and associated risk factors in lower limb trauma surgery patients.
• Identified risk factors can guide the development of targeted interventions and comprehensive preoperative assessments.
• Effective management strategies are crucial for reducing delirium incidence and improving overall patient outcomes in this vulnerable group.