(085) Brain Imaging Assessment of Intubated Traumatic Brain Injury Patients With and Without Delirium and Hematoma Location

Background: Traumatic Brain Injury (TBI) can have devastating effects on neuropsychiatric functioning. ‎‎50% of TBI patients develop delirium in the first 4 days after TBI2. Delirium is known to prolong ‎intubation, is associated with worse functional outcomes, and long-term cognitive impairments1. ‎However, the neuroanatomical basis for delirium in patients with TBI is currently uncertain3. We tested ‎the hypothesis that brain injury location is predictive of delirium in patients with TBI.‎

Methods: This IRB approved study utilized a retrospective chart review that included 132 charts of ‎individuals with TBI intubated in the neurocritical care setting. Patients were divided into 2 groups: ‎delirium versus no delirium (identified using ICD code) and their brain imaging results were reviewed ‎for injury location.‎

Results: There were 48 intubated TBI patients with delirium evaluated. The average age was 47 years ‎old and majority were male (81%). Brain imaging showed majority of hematomas were located in the ‎frontal lobe (68%) and 44% of these injuries were bilateral. Overall, 54% of patients with delirium had ‎bilateral injury, regardless of TBI location. 13 patient (27%) had left sided only injury and 7 (15%) had ‎right sided only injury. Other injury locations seen involved subdural (n= 22, 47%), subarachnoid (n=24, ‎‎51%), intraparenchymal (n=19, 40%) and epidural (n=4) regions.‎

‎80 intubated TBI patients without delirium were evaluated. The majority had injury located in the ‎frontal lobe (47%). 13 patients (17%) were left sided only and 25 (33%) were right sided only. Other ‎injury locations seen were subdural (n=32, 40%), subarachnoid (n=25, 31%), combination SDH and SAH ‎‎(n=13), and epidural (n=4).‎

Thus, in the delirium group, majority of unilateral injuries were left sided only (n=13, 27%) compared ‎to 7 (15%) right only injuries. In the non-delirium group, majority were right sided (n=25, 33%), ‎compared to 13 (17%) left.‎

Discussion: While their study included a broader population than TBI alone, Naidech et al found that ‎right sided lesions predominated in patients with intracerebral hemorrhages and delirium3. In our ‎preliminary analysis, injury location for TBI patients with delirium were predominantly left sided, while ‎the non-delirium group was mostly right sided.‎

Conclusion: Prospective studies are needed to see if left sided injury in TBI is an increased risk factor ‎for delirium.‎

References: ‎
‎1. Jeon, K., Jeong, BH., et al. (2016). Impact of delirium on weaning from mechanical ventilation in ‎medical patients. Respirology Feb;21(2):313-20.‎
‎2. Maneewong, J., Maneeton, B. et al(2017). Delirium after a traumatic brain injury: predictors and ‎symptom patterns. Neuropsychiatric disease and treatment 13, 459-465‎
‎3. Naidech AM, Polnaszek KL, et al. Hematoma Locations Predicting Delirium Symptoms After ‎Intracerebral Hemorrhage. Neurocrit Care. 2016 Jun;24(3):397-403.‎