Garofano Jeffrey S, Nakase-Richardson Risa, Barnett Scott D, Yablon Stuart A, Evans Clea, Zaim Nadia
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
James A. Haley Veterans Hospital, Tampa, Florida, USA.
PM R. 2024 Feb;16(2):122-131. doi: 10.1002/pmrj.13025. Epub 2023 Aug 17.
There is a limited evidence-base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, or the degree to which delirium impacts the ability of adolescents to return to school or work.
To describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability 1 year post-injury was also examined.
Exploratory secondary analysis of prospectively collected data.
Free-standing rehabilitation hospital.
Severely injured TBI Model Systems neurorehabilitation admissions (n = 243; median Glasgow Coma Scale = 7). The sample was divided into three age groups (adolescents, 16-21 years, n = 63; adults 22-49 years, n = 133; older adults ≥50 years, n = 47).
Not applicable.
We assessed patients using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria and the Delirium Rating Scale-Revised 98 (DRS-R-98). The employability item from the Disability Rating Scale was the primary 1-year outcome.
Most items on the DRS-R-98 differentiated delirious from non-delirious adolescents. Only "delusions" differed among age groups. Among adolescents, delirium status 1 month post-TBI provided acceptable classification of employability prediction 1 year later (area under the curve [AUC]: 0.80, 95% confidence interval [CI]: 0.69-0.91, p < .001). Delirium symptom severity (AUC: 0.86, 95% CI: 0.68-1.03, SE: 0.09; p < .001) and days of post-traumatic amnesia (AUC: 0.85, 95% CI: 0.68-1.01, SE: 0.08; p < .001) provided excellent prediction of outcomes for TBI patients in delirium.
Delirium symptomatology was similar among age groups and useful in differentiating the delirium status within the adolescent TBI group. Delirium and symptom severity at 1 month post-TBI were highly predictive of poor outcomes. Findings from this study support the utility of DRS-R-98 at 1 month post-injury to inform treatment and planning.
描述青少年谵妄临床特征的证据基础有限。目前已知的情况大多是从成人研究或病因各异的样本中推断出来的。尚不清楚青少年所经历的症状是否与成人不同，或者谵妄对青少年恢复上学或工作能力的影响程度如何。
描述重度创伤性脑损伤（TBI）后青少年的谵妄症状。按青少年谵妄状态和年龄组比较症状。还研究了谵妄及其与受伤后1年青少年就业能力的关系。
对前瞻性收集的数据进行探索性二次分析。
独立康复医院。
TBI模型系统神经康复科收治的重伤患者（n = 243；格拉斯哥昏迷量表中位数 = 7）。样本分为三个年龄组（青少年，16 - 21岁，n = 63；成人，22 - 49岁，n = 133；老年人，≥50岁，n = 47）。
不适用。
我们使用《精神障碍诊断与统计手册》第四版（DSM - IV）诊断标准和谵妄评定量表修订版98（DRS - R - 98）对患者进行评估。残疾评定量表中的就业能力项目是主要的1年结局指标。
DRS - R - 98上的大多数项目可区分有谵妄和无谵妄的青少年。只有“妄想”在年龄组之间存在差异。在青少年中，TBI后1个月的谵妄状态对1年后的就业能力预测提供了可接受的分类（曲线下面积[AUC]：0.80，95%置信区间[CI]：0.69 - 0.91，p <.001）。谵妄症状严重程度（AUC：0.86，95% CI：0.68 - 1.03，标准误：0.09；p <.001）和创伤后遗忘天数（AUC：0.85，95% CI：0.68 - 1.01，标准误：0.08；p <.001）对谵妄状态下的TBI患者结局具有出色的预测能力。
各年龄组的谵妄症状相似，有助于区分青少年TBI组内的谵妄状态。TBI后1个月的谵妄及症状严重程度对不良结局具有高度预测性。本研究结果支持DRS - R - 98在受伤后1个月用于指导治疗和规划的效用。
