Duration of the posttraumatic confusional state after moderate and severe traumatic brain injury: impact of injury severity and preinjury factors.

INTRODUCTION

This study aimed to estimate the duration, of the posttraumatic confusional state (PTCS), and predictors of the duration after moderate and severe traumatic brain injury (TBI) in a prospective inception cohort.

MATERIALS AND

METHODS

In 424 surviving neurosurgical patients with moderate [Glasgow Coma Scale (GCS) score 9-13] or severe TBI (GCS score ≤ 8), PTCS duration was estimated from sources documenting confusion or amnesia. Associations between PTCS duration and age, sex, indices of injury severity, and proxies of cognitive (education) and brain reserve (preinjury brain-related disability) were analyzed using binary logistic regression.

RESULTS

The most common PTCS duration was ≤ 7 days in the moderate TBI group (58%) and >28 days in the severe TBI group (52%). In multivariable analyses, lower age (p < 0.001), higher education, higher GCS score (p < 0.001), lower Rotterdam CT score (p = 0.004-0.002) and no road traffic accident (p = 0.006) were associated with a PTCS duration ≤ 7 days. Higher age (p < 0.001), lower GCS score (p < 0.001), and higher Rotterdam CT score (p < 0.001) were associated with a PTCS duration >28 days. Proxies of brain reserve were not independently associated with PTCS duration.

CONCLUSION

Cognitive reserve was associated with short, but not long, PTCS, while the proxy of brain reserve was not associated with PTCS. Age and injury-related variables were most consistently associated with PTCS duration. These results support the notion that PTCS is a foreseeable clinical phase after TBI, determined mainly by the brain injury itself.