Retrospective study of delirium in patients with major burn injuries at the Victorian Adult Burns Service

Dr Nupur Shukla, Dr Ignatius  Rudd, Dr

Hannah  Dobson, Mr Cheng Lo, Miss Heather Cleland

Abstract:

Delirium affects acutely unwell patients and is associated with poor patient outcomes. Precipitating factors include shock, multiple surgeries, ICU admission, and opioid use all of which commonly occur in patients with burn injuries (ACSQHC, 2016). Delirium remains to be  underdiagnosed (Kalish, Gillham & Unwin, 2014). Current literature demonstrates variable rates of delirium in burns patients (Van Yperen et al. 2020; Agarwal et al. 2016).

In this retrospective cohort study all patients aged 18 years and older with major burn injuries (20% and greater) admitted to the Victorian Adult Burns Service between 2010 to 2019 have been reviewed. The aims are to delineate rates of delirium, stratify risk factors and determine its association with increased morbidity. Our data has shown that 47.1% of patients in this cohort had delirium. No systematic screening tool was utilised in diagnosing delirium. It is based on the treating physician identifying delirium. Our study has shown that patients with delirium are of an older age, have a higher total body surface area of burn injury, increased length of stay in ICU and higher rehabilitation requirements. There are increased rates of delirium in patients with a previous psychiatric diagnosis and substance use disorder.

Patients with major burns are a high-risk cohort, delirium is associated with increased morbidity and there are inconsistencies in how it is diagnosed. Given these results we aim to conduct a prospective study using a bed side screening tool, the 4AT score, to improve detection and treatment of delirium (Wand, Smerdely, Hunt, 2016).

References:

Agarwal, V, OʼNeill, P.J, Cotton, B.A, Pun, B.T, Haney, S, Thompson, J, Kassebaum, N, Shintani, A, Guy, J, Ely, E.W, Pandharipande, P, 2010, Prevalence and Risk Factors for Development of Delirium in Burn Intensive Care Unit Patients, Journal of Burn Care & Research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773484/

Australian Commission on Safety and Quality in Health Care 2016, Indicator Specification: Delirium Clinical Care Standard, ACSQHC, viewed 2 February 2021 https://www.safetyandquality.gov.au/sites/default/files/migrated/Delirium-CCS_Indicators-PDF.pdf

De, J, Wand, A, Smerdely, P, Hunt, G 2016, Validating the 4A’s test in screening for delirium in a culturally diverse geriatric inpatient population, International Journal of Geriatric Psychiatry https://onlinelibrary.wiley.com/doi/full/10.1002/gps.4615?casa_token=l5QHq2fCp18AAAAA%3Atg5xtOqdizJYsfD_wLdq68Xx0GL_m63vVaQdhlWojT73-HPVakFyt3HklIef_gjb1rmh3WyxaV3H5q6b

Kalish, V, Gillham, J, Unwin, B 2014, Delirium in Older Persons: Evaluation and Management, American Family Physician < https://www.aafp.org/afp/2014/0801/p150.html>

Van Yperen, DT, Raats JW, Dokter J, Ziere G, Roukema GR, van Baar ME, van der Vlies CH 2020, Prevalence and Risk Factors for Delirium in Elderly Patients With Severe Burns: A Retrospective Cohort Study, Journal of Burn Care and Research, Oxford Academic < https://pubmed.ncbi.nlm.nih.gov/31504611/>


Biography:

Nupur is a current Plastic Surgery Registrar with a keen interest in research

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