• Silky Chotai, Jeffrey W Chen, Robert Turer, Candice Smith, Patrick D Kelly, Akshay Bhamidipati, Philip Davis, Jack T McCarthy, Gabriel A Bendfeldt, Mary B Peyton, Bradley M Dennis, Douglas P Terry, Oscar Guillamondegui, and Aaron M Yengo-Kahn.
• Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA.
• Neurosurgery. 2023 Dec 1; 93 (6): 142514311425-1431.

BackgroundFrequent neurological examinations in patients with traumatic brain injury (TBI) disrupt sleep-wake cycles and potentially contribute to the development of delirium.ObjectiveTo evaluate the risk of delirium among patients with TBI with respect to their neuro-check frequencies.MethodsA retrospective study of patients presenting with TBI at a single level I trauma center between January 2018 and December 2019. The primary exposure was the frequency of neurological examinations (neuro-checks) assigned at the time of admission. Patients admitted with hourly (Q1) neuro-check frequencies were compared with those who received examinations every 2 (Q2) or 4 (Q4) hours. The primary outcomes were delirium and time-to-delirium. The onset of delirium was defined as the first documented positive Confusion Assessment Method for the Intensive Care Unit score.ResultsOf 1552 patients with TBI, 458 (29.5%) patients experienced delirium during their hospital stay. The median time-to-delirium was 1.8 days (IQR: 1.1, 2.9). Kaplan-Meier analysis demonstrated that patients assigned Q1 neuro-checks had the greatest rate of delirium compared with the patients with Q2 and Q4 neuro-checks ( P < .001). Multivariable Cox regression modeling demonstrated that Q2 neuro-checks (hazard ratio: 0.439, 95% CI: 0.33-0.58) and Q4 neuro-checks (hazard ratio: 0.48, 95% CI: 0.34-0.68) were protective against the development of delirium compared with Q1. Other risk factors for developing delirium included pre-existing dementia, tobacco use, lower Glasgow Coma Scale score, higher injury severity score, and certain hemorrhage patterns.ConclusionPatients with more frequent neuro-checks had a higher risk of developing delirium compared with those with less frequent neuro-checks.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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