The Journal of surgical research · 2025
Risk Factors for Delirium in Trauma Elderly Patients: An Analysis Using the National Trauma Data Bank From 2021 to 2022: A Retrospective Cohort Study.
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Mendez Reyes Jose Euberto, Miles Travis J, Seger Catherine, Wilson Chad
Аннотация
INTRODUCTION: Delirium is a common and serious condition among hospitalized elderly patients, often underdiagnosed and associated with adverse outcomes. Currently, there is a gap in the understanding of delirium risk factors in trauma patients, which are crucial for effective recognition, prevention, and management.
METHODS: We queried the National Trauma Data Bank for 2021 and 2022 and restricted the cohort to patients 65 y and above. Descriptive statistics were used to characterize the study population and assess crude associations. Logistic regression was performed to assess the association between various patient characteristics and the risk of delirium.
RESULTS: A total of 822,591 patients were included in the analysis. The prevalence of delirium was 2.3% (18,134/822,591). On multivariate regression, our analysis revealed several significant risk factors associated with delirium among elderly patients. Notably, previous history of dementia (odds ratio [OR] [95% confidence interval [CI]]: 1.67 [1.59-1.75]), functionally dependent health status (OR [95% CI]: 1.61 [1.55-1.68]), history of a bleeding disorder (OR [95% CI]: 1.60 [1.42-1.80]), and male sex (OR [95% CI]: 1.49 [1.44-1.55]) had increased odds of developing delirium. Being of Hispanic ethnicity was associated with lower odds of developing delirium compared to non-Hispanics (OR [95% CI]: 0.53 [0.48-0.59]). Being transferred from another facility was significant on unadjusted analysis (P < 0.001) but not significant after multivariate analysis (OR [95% CI]: 1.00 [0.96-1.05]).
CONCLUSIONS: Our findings suggest that delirium is likely underdiagnosed in elderly trauma patients, as reflected by the low documented prevalence in National Trauma Data Bank. Still, the study identifies key risk factors, including significant associations with sex and ethnicity, which may indicate potential disparities in delirium diagnosis, rather than actual variation in incidence (i.e., language barriers or social bias). Improving detection, especially across diverse populations, may help reduce incidence and severity of delirium, ultimately improving outcomes and quality of care.
METHODS: We queried the National Trauma Data Bank for 2021 and 2022 and restricted the cohort to patients 65 y and above. Descriptive statistics were used to characterize the study population and assess crude associations. Logistic regression was performed to assess the association between various patient characteristics and the risk of delirium.
RESULTS: A total of 822,591 patients were included in the analysis. The prevalence of delirium was 2.3% (18,134/822,591). On multivariate regression, our analysis revealed several significant risk factors associated with delirium among elderly patients. Notably, previous history of dementia (odds ratio [OR] [95% confidence interval [CI]]: 1.67 [1.59-1.75]), functionally dependent health status (OR [95% CI]: 1.61 [1.55-1.68]), history of a bleeding disorder (OR [95% CI]: 1.60 [1.42-1.80]), and male sex (OR [95% CI]: 1.49 [1.44-1.55]) had increased odds of developing delirium. Being of Hispanic ethnicity was associated with lower odds of developing delirium compared to non-Hispanics (OR [95% CI]: 0.53 [0.48-0.59]). Being transferred from another facility was significant on unadjusted analysis (P < 0.001) but not significant after multivariate analysis (OR [95% CI]: 1.00 [0.96-1.05]).
CONCLUSIONS: Our findings suggest that delirium is likely underdiagnosed in elderly trauma patients, as reflected by the low documented prevalence in National Trauma Data Bank. Still, the study identifies key risk factors, including significant associations with sex and ethnicity, which may indicate potential disparities in delirium diagnosis, rather than actual variation in incidence (i.e., language barriers or social bias). Improving detection, especially across diverse populations, may help reduce incidence and severity of delirium, ultimately improving outcomes and quality of care.