Prevalence of Delirium in Patients With Traumatic Brain Injury at the Kenyatta National Hospital

Abstract

Introduction Delirium presents with acute cognitive dysfunction and is reversible. It is common and predictable in traumatic brain injury (TBI) patients. It is often underdiagnosed, unrecognized; and occurs in about 20% of hospitalized patients and up to 69% of TBI patients. Delirium in TBI patients increases mechanical ventilation days, hospital stay, and 6-month mortality. Therefore, patients with TBI require regular monitoring with a validated delirium assessment instrument. Objective The general study objective was to determine the delirium prevalence among patients with traumatic brain injury at Kenyatta National Hospital (KNH). Materials and Methods The study was a cross-sectional, observational, descriptive study. The study site was the surgical wards and the critical care surgical units at the Kenyatta National Hospital. A checklist questionnaire based on the Intensive Care Delirium Screening Checklist (ICDSC) was filled out by the principal investigator on sampled TBI patients. It was used to screen admitted patients for delirium and identify possible risk factors. The checklist questionnaire was coded into the encrypted Google Forms™ application for data entry. Results We evaluate 119 patients with TBI sampled consecutively from the admission register at the KNH. The prevalence of delirium was 61.3% in TBI patients at the KNH. The evaluated risk factors of delirium were; female gender (male vs. female; PR, 0.87; 95% CI, 0.75 to1.79), severe TBI with GCS<9 (severe vs. non-severe TBI; PR, 1.5; 95% CI, 0.89 to 1.5), use of restraints (higher in use of restraints vs. no use; PR,1.47; 95% CI 0.90 to 1.50), use of sedatives (higher in use of sedatives vs. no use; PR, 1.45; 95% CI 0.89 to 1.51), absence of neurosurgical intervention (less in patients with neurosurgical intervention than those without (PR, 0.88; 95% CI 0.87 to 1.54), and higher when blood transfusion was done (PR, 1.34; 95% CI 0.82 to 1.64). 12 Conclusion The prevalence of delirium was 61.3% in TBI patients at the KNH. Severe TBI with GCS<9, use of restraints, and exposure to sedatives were risk factors for delirium