Incidence and delirium risk factors in burn patients: A prospective cohort study

Delirium is a neurocognitive syndrome caused by systemic disturbances, leading to impaired attention, awareness, and/or cognition. It poses a significant risk of comorbidities, mortality, prolonged hospitalization, and increased healthcare costs. The challenges in delirium management, follow-up, and rehabilitation, arising from complex chronic conditions and long-term complications after severe burns, highlight the urgent need for more research in this area. Thus, this study aims to investigate the incidence of delirium and the risk factors specific to this population.

This analytical observational prospective cohort study was conducted between August 2022 and January 2024. Adults (18 years and older) admitted to a single burn unit with a confirmed burn injury were included, regardless of burn severity. Sociodemographic and clinical variables included age, sex, extent of burn, and prior health status. Delirium assessment was made using the CAM-ICU scale at least twice a day. The primary outcome was the incidence of delirium and its risk factors, with secondary outcomes including the onset and duration of delirium episodes.

The sample consisted of 50 patients, with a delirium incidence of 52 %. Burn patients admitted to the burn unit developed delirium an average of 11.81 days (95 % CI=7.09-16.52) after hospitalization, with an average duration of 11.5 days (95 % CI = 7.28-15.72). Age was the only predisposing risk factor that emerged (p = 0.0141). Five variables emerged as precipitating risk factors in bivariate analyses: total surface burn area (TSBA) (p = 0.026), surgery (p = 0.0438), mechanical ventilation (p < 0.001), opioid infusion use (p < 0.001), and infection (p < 0.001). However, in multivariate Cox regression analyses, only mechanical ventilation remained statistically significant as a risk factor for delirium (HR=8.017; 95 % CI = 1.926 - 33.368; p = 0.004).

This study highlights mechanical ventilation as a critical risk factor contributing to the high incidence of delirium among burn patients. Early identification and management of risk factors-mainly mechanical ventilation, but also TSBA, surgery, opioid infusion use, and infection-can guide targeted interventions to improve patient outcomes and mitigate the impact of delirium on recovery.