Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Neurology
Published in: Journal of Neurology 12/2023

27-08-2023 | Central Nervous System Trauma | Original Communication

Prevention and treatment of traumatic brain injury-related delirium: a systematic review

Authors: Yu Qing Huang, Sophie Weiss, Priti Gros, Edwin Wong, Pierre-Philippe Piché, Manav V. Vyas, Alan Ka Ho Tam, Jennifer Ann Watt

Published in: Journal of Neurology | Issue 12/2023

Login to get access

Abstract

Background

Our systematic review examines the effectiveness and safety of non-pharmacologic and pharmacologic interventions in preventing or treating traumatic brain injury (TBI)-related delirium in acute care.

Methods

We searched four electronic databases (MEDLINE, EMBASE, CENTRAL/CDSR, and PsycINFO) to identify randomized controlled trials (RCTs), quasi-experimental, and observational studies. Eligible studies included adults with TBI, at least one comparator group, delirium as an outcome and took place in acute care. Two reviewers independently completed all study screening, data abstraction, and risk of bias assessment using the Cochrane risk of bias 2 tool for RCTs or risk of bias in non-randomized studies—of interventions tool for observational studies. We implemented the PROGRESS-Plus framework to describe social determinants of health (SDoH) reporting.

Results

We identified 20,022 citations, reviewed 301 in full text, and included eight studies in the descriptive synthesis. The mean age of study participants ranged from 32 to 62 years. 12.5% of included studies reported SDoH. Included studies had moderate-to-high risk of bias. Studies compared reorientation programs and an intervention bundle to usual care, but these interventions were not better than usual care in treating TBI-related delirium. Individual studies found that rosuvastatin and aripiprazole were more efficacious than placebo, and dexmedetomidine was more efficacious than propofol and haloperidol for preventing TBI-related delirium. No studies reported safety as the primary outcome.

Conclusions

We identified efficacious pharmacologic interventions for preventing TBI-related delirium, but these studies were at moderate-to-high risk of bias, which limits our confidence in these findings. Future studies should incorporate safety outcomes, and a diverse study population, including older adults.
Appendix
Available only for authorised users
Literature
1.
Menon DK, Schwab K, Wright DW, Maas AI, Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health (2010) Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil 91:1637–1640CrossRefPubMed
2.
Eapen BC, Allred DB, O’Rourke J, Cifu DX (2015) Rehabilitation of moderate-to-severe traumatic brain injury. Semin Neurol 35:e1-3CrossRefPubMed
3.
Arciniegas DB, Anderson CA, Topkoff J, McAllister TW (2005) Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsychiatr Dis Treat 1:311–327PubMedPubMedCentral
4.
Ganau M, Lavinio A, Prisco L (2018) Delirium and agitation in traumatic brain injury patients: an update on pathological hypotheses and treatment options. Minerva Anestesiol 84:632–640CrossRefPubMed
5.
Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely EW (2020) Delirium. Nat Rev Dis Primer 6:1–26
6.
Wang H-K, Lin S-H, Sung P-S, Wu M-H, Hung K-W, Wang L-C, Huang C-Y, Lu K, Chen H-J, Tsai K-J (2012) Population based study on patients with traumatic brain injury suggests increased risk of dementia. J Neurol Neurosurg Psychiatry 83:1080–1085CrossRefPubMed
7.
Nakase-Richardson R, Yablon SA, Sherer M (2007) Prospective comparison of acute confusion severity with duration of post-traumatic amnesia in predicting employment outcome after traumatic brain injury. J Neurol Neurosurg Psychiatry 78:872–876CrossRefPubMed
8.
9.
Livingston G, Huntley J, Sommerlad A et al (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet Lond Engl 396:413–446CrossRef
10.
Sherer M, Katz DI, Bodien YG et al (2020) Post-traumatic confusional state: a case definition and diagnostic criteria. Arch Phys Med Rehabil 101:2041–2050CrossRefPubMed
11.
Povlishock JT, Katz DI (2005) Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil 20:76–94CrossRefPubMed
12.
13.
Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM (1999) A Multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676CrossRefPubMed
14.
15.
Maneewong J, Maneeton B, Maneeton N, Vaniyapong T, Traisathit P, Sricharoen N, Srisurapanont M (2017) Delirium after a traumatic brain injury: predictors and symptom patterns. Neuropsychiatr Dis Treat 13:459–465CrossRefPubMedPubMedCentral
16.
Flores-Sandoval C, Marshall S, Janzen S, Welch-West P, Harnett A, Ferri C, Teasell R (2022) Rehabilitation of learning and memory deficits post acquired brain injury. In: Teasell R, Cullen N, Marshall S, Janzen S, Bayley M (eds) Evidence-based review of moderate to severe acquired brain injury. Version 15.0. pp. 1–119
17.
18.
19.
20.
Oldham MA, MacLullich A, Slooter AJC (2021) Posttraumatic confusional state: delirium by another name. Arch Phys Med Rehabil 102:338–339CrossRefPubMed
21.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113:941–948CrossRefPubMed
22.
23.
24.
Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC (1995) Unrecognized delirium in ED geriatric patients. Am J Emerg Med 13:142–145
25.
26.
O’Neill J, Tabish H, Welch V et al (2014) Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol 67:56–64CrossRefPubMed
27.
Welch VA, Petkovic J, Jull J, Hartling L, Klassen T, Kristjansson E, Pardo Pardo J, Petticrew M, Stott DJ, Thomson D, Ueffing E, Williams K, Young C, Tugwell P (2023) Chapter 16: Equity and specific populations. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) Cochrane handbook for systematic reviews of interventions version 6.4 (updated August 2023). Cochrane. Available from www.​training.​cochrane.​org/​handbook
28.
Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ l4898
29.
Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ i4919
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
Chróinín DN, Francis N, Wong P, Kim YD, Nham S, D’Amours S (2021) Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty. Trauma Surg Acute Care Open 6:e000639CrossRef
40.
41.
Kalish VB, Gillham JE, Unwin BK (2014) Delirium in older persons: evaluation and management. Am Fam Physician 90:150–158PubMed
42.
National Institute for Health and Clinical Excellence (2010) Delirium: diagnosis, prevention and management
43.
Munro CL, Cairns P, Ji M, Calero K, Anderson WM, Liang Z (2017) Delirium prevention in critically ill adults through an automated reorientation intervention—a pilot randomized controlled trial. Heart Lung J Crit Care 46:234–238CrossRef
44.
Colombo R, Corona A, Praga F, Minari C, Giannotti C, Castelli A, Raimondi F (2012) A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study. Minerva Anestesiol 78:1026–1033PubMed
45.
Devlin JW, Skrobik Y, Gélinas C et al (2018) Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 46:e825–e873CrossRefPubMed
46.
Ponsford J, Trevena-Peters J, Janzen S et al (2023) INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, part I: posttraumatic amnesia. J Head Trauma Rehabil 38:24CrossRefPubMed
47.
Roberson SW, Patel MB, Dabrowski W, Ely EW, Pakulski C, Kotfis K (2021) Challenges of delirium management in patients with traumatic brain injury: from pathophysiology to clinical practice. Curr Neuropharmacol 19:1519–1544CrossRefPubMedPubMedCentral
48.
49.
Meeks JR, Bambhroliya AB, Sheth SA et al (2020) Long-term cognitive impairment associated with delirium in acute neurological injury. Crit Care Explor 2:e0130CrossRefPubMedPubMedCentral
50.
Gardner RC, Burke JF, Nettiksimmons J, Kaup A, Barnes DE, Yaffe K (2014) Dementia risk after traumatic brain injury vs nonbrain trauma: the role of age and severity. JAMA Neurol 71:1490–1497CrossRefPubMedPubMedCentral
51.
52.
53.
Metadata
Title
Prevention and treatment of traumatic brain injury-related delirium: a systematic review
Authors
Yu Qing Huang
Sophie Weiss
Priti Gros
Edwin Wong
Pierre-Philippe Piché
Manav V. Vyas
Alan Ka Ho Tam
Jennifer Ann Watt
Publication date
27-08-2023
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 12/2023
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-023-11889-7

Other articles of this Issue 12/2023

Journal of Neurology 12/2023 Go to the issue

Review

Facial expression recognition deficits in frontotemporal dementia and Alzheimer’s disease: a meta-analytic investigation of effects of phenotypic variant, task modality, geographical region and symptomatic specificity

Original Communication

Cognitive impairment and dementia in young onset Parkinson’s disease

Letter to the Editors

New phenotype of a functional orofacial movement disorder

Original Communication

Characteristics of the muscle involvement along the disease progression in a large cohort of oculopharyngodistal myopathy compared to oculopharyngeal muscular dystrophy

Original Communication

Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage

Original Communication

Outcomes of mechanical thrombectomy in orally anticoagulated patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Imperial College Thrombectomy Registry