Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage

Christine M Abraham, William T Obremskey, Yanna Song, James C Jackson, E Wesley Ely, Kristin R Archer
Archives of Physical Medicine and Rehabilitation 2014, 95 (12): 2382-9

OBJECTIVES: To determine whether delirium during the hospital stay predicted health-related quality of life (HRQOL) at 1 year after injury in trauma intensive care unit (ICU) survivors without intracranial hemorrhage, and to examine the association between depressive and posttraumatic stress disorder (PTSD) symptoms and each of the HRQOL domains at 1-year follow-up.

DESIGN: Prognostic cohort with a 1-year follow-up.

SETTING: Level 1 trauma ICU.

PARTICIPANTS: Adult patients without intracranial hemorrhage (N=173) admitted to a level 1 trauma ICU.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: HRQOL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey at 1 year after traumatic injury.

RESULTS: Average delirium duration ± SD was .51±1.1 days. Hierarchical multivariable linear regression analyses did not find a statistical relationship between delirium and HRQOL at 1-year follow-up. However, increased levels of depressive symptoms at 1 year were statistically associated with poorer functioning in all physical and mental health HRQOL domains, whereas PTSD at 1 year was statistically associated with all HRQOL domains except role-physical (P<.05).

CONCLUSIONS: There was no statistical association between delirium during the hospital stay and HRQOL at 1 year, which may be due to the short time spent in delirium by our study population. Depressive symptoms demonstrated a stronger relationship with mental and physical HRQOL domains at 1 year than PTSD, indicating their own unique pathway after trauma. Findings lend support for the separate assessment and management of depression and PTSD. Additional research on the duration and subtypes of delirium is needed within the trauma ICU population, as the effects are not widely known.

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