Delirium is a common, severe and acute neuropsychiatric syndrome that affects mainly older patients. Delirium is a well-recognised complication of trauma and is important as it is associated with an increase in mortality as well as cognitive and functional decline, increased length of hospital stay and increased risk of institutionalisation on discharge. Recognition and management is challenging and the psychological impact for patients and relatives devastating. This review discusses the current understanding of delirium with specific reference to trauma patients.
MartinsSFernandesL. Delirium in elderly people: a review. Front Neurol2012; 3: 101–101.
2.
MaclullichAMAnandADavisDH. New horizons in the pathogenesis, assessment and management of delirium. Age Ageing2013; 42: 667–674.
3.
FearingMAInouye DeliriumSKBlazerDGSteffensDC. The American Psychiatric Publishing textbook of geriatric psychiatry, Washington: American Psychiatric Publishing, 2009, pp. 229–241.
4.
WitloxJEurelingsLSde JongheJF. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA2010; 304: 443–451.
5.
KatMGde JongheJFVreeswijkR. Mortality associated with delirium after hip-surgery: a 2-year follow-up study. Age Ageing2011; 40: 312–318.
6.
YoungJInouyeSK. Delirium in older people. BMJ2007; 334: 842–846.
7.
RyanDJO'ReganNACaoimhR. Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ Open2013; 3: e001772–e001772.
8.
PisaniMAMcNicollLInouyeSK. Cognitive impairment in the intensive care unit. Clin Chest Med2003; 24: 727–737.
9.
BruceAJRitchieCWBlizardR. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr2007; 19: 197–214.
10.
LeeKHHaYCLeeYK. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res2011; 469: 2612–2620.
11.
BrancoBCInabaKBukurM. Risk factors for delirium in trauma patients: the impact of ethanol use and lack of insurance. Am Surg2011; 77: 621–626.
12.
PandharipandePCottonBAShintaniA. Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma2008; 65: 34–41.
13.
BlondellRDPowellGEDoddsHN. Admission characteristics of trauma patients in whom delirium develops. Am J Surg2004; 187: 332–337.
14.
SaxenaSLawleyD. Delirium in the elderly: a clinical review. Postgrad Med J2009; 85: 405–413.
15.
MarcantonioERGoldmanLMangioneCM. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA1994; 271: 134–139.
16.
AlagiakrishnanKWiensCA. An approach to drug induced delirium in the elderly. Postgrad Med J2004; 80: 388–393.
17.
HanLMcCuskerJColeM. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med2001; 161: 1099–1105.
18.
CerejeiraJFirminoHVaz-SerraA. The neuroinflammatory hypothesis of delirium. Acta Neuropathol2010; 119: 737–754.
19.
MaclullichAMFergusonKJMillerT. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res2008; 65: 229–238.
20.
HallRJMeagherDJMacLullichAM. Delirium detection and monitoring outside the ICU. Best Pract Res Clin Anaesthesiol2012; 26: 367–383.
21.
InouyeSK. Delirium in older persons. N Engl J Med2006; 354: 1157–1165.
22.
GuillamondeguiODRichardsJEElyEW. Does hypoxia affect intensive care unit delirium or long-term cognitive impairment after multiple trauma without intracranial hemorrhage?J Trauma2011; 70: 910–915.
23.
SiddiqiNHouseAOHolmesJD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing2006; 35: 350–364.
24.
KielyDKJonesRNBergmannMA. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci2007; 62: 174–179.
25.
ColeMG. Delirium in elderly patients. Am J Geriatr Psychiatr2004; 12: 7–21.
26.
YoungJ. Red flags in geriatrics: diagnoses not to be missed in acute units. Clin Med2007; 7: 512–514.
27.
HoltYM. Physical signs of delirium2010.
28.
National Institute for Health and Care Excellence. Delirium (CG103). London: National Institute for Health and Care Excellence, 2010.
29.
TrzepaczPTBakerRWGreenhouseJ. A symptom rating scale for delirium. Psychiatr Res1988; 23: 89–97.
30.
InouyeSKvan DyckCHAlessiCA. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med1990; 113: 941–948.
31.
Maclullich A. The 4 AT, www.the4at.com/ (2013, accessed 22 February 2014).
32.
SmithTHameedYCrossJ. Assessment of people with cognitive impairment and hip fracture: a systematic review and meta-analysis. Arch Gerontol Geriatr2013; 57: 117–126.
33.
SojaSLPandharipandePPFlemingSB. Implementation, reliability testing, and compliance monitoring of the confusion assessment method for the intensive care unit in trauma patients. Intensive Care Med2008; 34: 1263–1268.
34.
HempeniusLvan LeeuwenBLvan AsseltDZ. Structured analyses of interventions to prevent delirium. Int J Geriatr Psychiatr2011; 26: 441–450.
35.
SiddiqiNStockdaleRBrittonAM. Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev2007; 2: CD005563–CD005563.
36.
MarcantonioERFlackerJMWrightRJ. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc2001; 49: 516–522.
37.
InouyeSKBogardusSTBakerDI. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc2000; 48: 1697–1706.
38.
KalisvaartKJde JongheJFBogaardsMJ. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc2005; 53: 1658–1666.
39.
VochtelooAJMoermanSvan der BurgBL. Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium. BMC Geriatr2011; 11: 39–39.
40.
MarcantonioERPalihnichKAppletonP. Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture. J Am Geriatr Soc2011; 59(Suppl 2): S282–S288.
41.
FongTGTulebaevSRInouyeSK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol2009; 5: 210–220.
42.
Canadian Coalition for Seniors' Mental Health. National Guidelines for Seniors Mental Health – The assessment and treatment of delirium. Toronto: Canadian Coalition for Seniors' Mental Health, 2006.
43.
BourneRSTahirTABorthwickM. Drug treatment of delirium: past, present and future. J Psychosom Res2008; 65: 273–282.
44.
ParkerMJHandollHHGriffithsR. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev2004; 4: CD000521–CD000521.
45.
ZhangHLuYLiuM. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care2013; 17: R47–R47.
46.
SieberFEZakriyaKJGottschalkA. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc2010; 85: 18–26.
47.
RobinsonBRMuellerEWHensonK. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma2008; 65: 517–526.
