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Open Access

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Danielle Ní Chróinín, Nevenka Francis, Pearl Wong, Yewon David Kim, Susan Nham, Scott D'Amours
DOI: 10.1136/tsaco-2020-000639 Published 27 April 2021
Danielle Ní Chróinín
1Department of Geriatric Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
2South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
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  • ORCID record for Danielle Ní Chróinín
Nevenka Francis
2South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
3Acute Care Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
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Pearl Wong
4Department of Head and Neck Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
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Yewon David Kim
5Department of Plastic Surgery, Liverpool Hospital, Liverpool, UK
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Susan Nham
2South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
6Department of Haematology, Liverpool Hospital, Liverpool, UK
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Scott D'Amours
2South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
3Acute Care Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
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  • Table 1

    Patient characteristics (n=99)

    Patient characteristicsWhole group (n=99)Patients without diagnosis of delirium (n=76)Patients with delirium (n=23)P value
    Age (years), mean (SD)79.2 (7.9)77.7 (0.8)84.0 (1.7)<0.001
    Female sex, n (%)50 (51.5)40 (52.6)10 (43.5)0.48
    ISS, median (IQR)9 (4–14)9 (4–14)9 (4.5–10)0.93
    Primary injury, n (%)
     Rib fracture29 (29)22 (29)7 (30)0.68
     Other fracture22 (22)16 (21)6 (26)
     Head injury21 (21)16 (21)5 (22)
     Other traumatic injury18 (18)16 (21)2 (9)
     No injury*9 (9)6 (8)3 (13)
    From RACF (nursing home), n (%)14 (14)9 (12)5 (22)0.30
    Baseline frailty
     CFS, median (IQR)4 (3–6)3 (3–5)6 (5–6)<0.001
     Proportion frail†, n (%)44 (45)25 (33)19 (83)<0.001
    History of dementia‡16 (16)5 (7)11 (48)<0.001
    Outcomes
    LOS
     Median (IQR)6 (2–16)4 (1–10.5)17 (6–27)<0.001
     Long LOS§, n (%)25 (25.25)13 (17.1)12 (52.2)0.001
    Selected complications, n (%)
     Any complication29 (29)19 (25)10 (44)0.09
     Cardiovascular16 (16)10 (13)6 (26)0.14
     Respiratory9 (9)5 (7)4 (17)0.11
     Venous thromboembolism0 (0)0 (0)0 (0)1.0
     Pressure injury0 (0)0 (0)0 (0)1.0
     Deconditioning5 (5)2 (3)3 (13)0.08
    In-hospital death9 (9)6 (8)3 (13)0.43
    • *These patients presented with suspected traumatic injury, for example, due to the mechanism of (potential) injury, or fall with loss of consciousness or similar, but were subsequently determined to have an ISS score of 0.

    • †Frail defined as CFS ≥5.

    • ‡Among the 16 patients identified as having a history of dementia, the subtype was unspecified in 9/16, Alzheimer’s in 2/16, vascular in 3/16 and one patient had mixed dementia.

    • §Long LOS defined as highest quartile, ≥16 days.

    • CFS, Clinical Frailty Score; ISS, Injury Severity Score; LOS, loss of consciousness; RACF, residential aged care facility.

  • Table 2

    Multivariable logistic regression analysis of factors associated with long LOS (highest quartile, ≥16 days)

    VariableOR for long LOS95% CIP value
    Delirium4.811.59 to 14.470.005
    Any (non-delirium) complication*5.962.09 to 16.970.001
    • Frailty was included in an earlier multivariable analysis (as was not strongly associated with delirium (correlation coefficient 0.44), as per the a priori statistical plan, but excluded from the final model as it did not meet statistical significance.

    • *From selected in-hospital complications (see text).

    • LOS, length of stay.

Supplementary Materials

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    [tsaco-2020-000639supp001.pdf]

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty
Danielle Ní Chróinín, Nevenka Francis, Pearl Wong, Yewon David Kim, Susan Nham, Scott D'Amours
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000639; DOI: 10.1136/tsaco-2020-000639

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Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty
Danielle Ní Chróinín, Nevenka Francis, Pearl Wong, Yewon David Kim, Susan Nham, Scott D'Amours
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000639; DOI: 10.1136/tsaco-2020-000639
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Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty
Danielle Ní Chróinín, Nevenka Francis, Pearl Wong, Yewon David Kim, Susan Nham, Scott D'Amours
Trauma Surgery & Acute Care Open Apr 2021, 6 (1) e000639; DOI: 10.1136/tsaco-2020-000639
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