M. Safdar1, H. Khurshid1, Q. Alizai1, A. L. Spencer1, O. Hejazi1, A. Nelson1, H. Hosseinpour1, C. Stewart1, S. Bhogadi1, M. Ditillo1, L. J. Magnotti1, B. Joseph1 1University Of Arizona, Division Of Trauma, Critical Care, Burns, And Emergency Surgery, Department Of Surgery, Tucson, AZ, USA
Introduction: Delirium is a common complication among patients with traumatic brain injuries (TBI). However, there is a paucity of data on the effect of pre-injury substance (alcohol, drugs) abuse on the risk of delirium in TBI patients. The aim of this study was to assess the incidence of delirium among patients with blunt TBI in association with different substances.
Methods: This is a retrospective analysis of ACS-TQIP (2020). We included all adult (18-65yrs) patients with blunt TBI (Head AIS>1) who received substance screening (Blood/urine). We excluded burn patients, those with prehospital cardiac arrest, and those who died within 24 hours of arrival. Patients were stratified based on the results of screening tests for stimulants (amphetamine, methamphetamine, cocaine, ecstasy), depressants (barbiturates, benzodiazepines, methadone, opioid, oxycodone), hallucinogens (phencyclidine and cannabinoids), tricyclic antidepressants (TCAs), and alcohol. Our primary outcome was the incidence of delirium. Secondary outcomes included mortality, complications, and hospital and ICU length of stay (LOS) comparing patients with and without delirium. Multivariable regression analyses were performed, adjusting for potential confounders.
Results: We identified 46,351 blunt TBI patients. The mean(SD) age was 42(14)yrs and 75% were male. Median ISS was 16[10-22]. Among the study population, 33% patients tested positive for drugs and 37% tested positive for Alcohol. Overall, 755 (1.6%) experienced delirium. On univariate analysis, rates of delirium were significantly high in association with isolated stimulant or TCA use, however, isolated depressants or alcohol use was not associated with delirium (Table 1A). Notably, positive screening tests for amphetamines, methamphetamines, TCAs, and cannabinoids was associated with high rates of delirium (Table 1A). Furthermore, delirium was associated with high rates of ICU admission and longer hospital and ICU LOS (Table 1B). On multivariable regression analyses, positive screen tests for all stimulants (aOR:1.3, 95%CI[1.04-1.61], p=0.018), amphetamine (aOR: 1.4, 95%CI[1.05-1.80], p=0.019), methamphetamine (aOR:1.7, 95%CI[1.15-2.63], p=0.008), and TCA(aOR2.9, 95%CI[1.09-8.91], p=0.033) were independently associated with higher odds of developing delirium.
Conclusion: One-third of adult patients with blunt TBI had a positive substance screening test on admission. Patients with positive stimulant tests were at higher risk of developing delirium, whereas this association was not evident with other drugs and alcohol positive tests. These findings emphasize the need for early drug screening in TBI patients and close monitoring of patients with a positive screening test for stimulants.
