Search

Background: There is a limited evidence-base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, or the degree to which delirium impacts the ability of adolescents to return to school or work., Objective: To describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability 1 year post-injury was also examined., Design: Exploratory secondary analysis of prospectively collected data., Setting: Free-standing rehabilitation hospital., Patients: Severely injured TBI Model Systems neurorehabilitation admissions (n = 243; median Glasgow Coma Scale = 7). The sample was divided into three age groups (adolescents, 16-21 years, n = 63; adults 22-49 years, n = 133; older adults ≥50 years, n = 47)., Interventions: Not applicable., Measures: We assessed patients using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria and the Delirium Rating Scale-Revised 98 (DRS-R-98). The employability item from the Disability Rating Scale was the primary 1-year outcome., Results: Most items on the DRS-R-98 differentiated delirious from non-delirious adolescents. Only "delusions" differed among age groups. Among adolescents, delirium status 1 month post-TBI provided acceptable classification of employability prediction 1 year later (area under the curve [AUC]: 0.80, 95% confidence interval [CI]: 0.69-0.91, p < .001). Delirium symptom severity (AUC: 0.86, 95% CI: 0.68-1.03, SE: 0.09; p < .001) and days of post-traumatic amnesia (AUC: 0.85, 95% CI: 0.68-1.01, SE: 0.08; p < .001) provided excellent prediction of outcomes for TBI patients in delirium., Conclusions: Delirium symptomatology was similar among age groups and useful in differentiating the delirium status within the adolescent TBI group. Delirium and symptom severity at 1 month post-TBI were highly predictive of poor outcomes. Findings from this study support the utility of DRS-R-98 at 1 month post-injury to inform treatment and planning., (© 2023 American Academy of Physical Medicine and Rehabilitation.)

Background: There is a limited evidence‐base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, or the degree to which delirium impacts the ability of adolescents to return to school or work. Objective: To describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability 1 year post‐injury was also examined. Design: Exploratory secondary analysis of prospectively collected data. Setting: Free‐standing rehabilitation hospital. Patients: Severely injured TBI Model Systems neurorehabilitation admissions (n = 243; median Glasgow Coma Scale = 7). The sample was divided into three age groups (adolescents, 16–21 years, n = 63; adults 22–49 years, n = 133; older adults ≥50 years, n = 47). Interventions: Not applicable. Measures: We assessed patients using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) diagnostic criteria and the Delirium Rating Scale‐Revised 98 (DRS‐R‐98). The employability item from the Disability Rating Scale was the primary 1‐year outcome. Results: Most items on the DRS‐R‐98 differentiated delirious from non‐delirious adolescents. Only "delusions" differed among age groups. Among adolescents, delirium status 1 month post‐TBI provided acceptable classification of employability prediction 1 year later (area under the curve [AUC]: 0.80, 95% confidence interval [CI]: 0.69–0.91, p <.001). Delirium symptom severity (AUC: 0.86, 95% CI: 0.68–1.03, SE: 0.09; p <.001) and days of post‐traumatic amnesia (AUC: 0.85, 95% CI: 0.68–1.01, SE: 0.08; p <.001) provided excellent prediction of outcomes for TBI patients in delirium. Conclusions: Delirium symptomatology was similar among age groups and useful in differentiating the delirium status within the adolescent TBI group. Delirium and symptom severity at 1 month post‐TBI were highly predictive of poor outcomes. Findings from this study support the utility of DRS‐R‐98 at 1 month post‐injury to inform treatment and planning. [ABSTRACT FROM AUTHOR]

Background: TBI is a leading cause of disability among veterans and active duty military personnel, and presents an obstacle to community reintegration. Prior studies examining adult survivors of TBI pursuing postsecondary education have methodological flaws that limit the understanding the scope and severity of sequelae experienced by persons with TBI who attend college. Objective: To describe (a) physical and cognitive functioning, and (b) postconcussion and mental health symptoms in veterans and military personnel (V/M) with traumatic brain injury (TBI) enrolled in postsecondary education programs after discharge from rehabilitation. Method: Cross-sectional study. Participants were recruited from five Veterans Affairs (VA) Polytrauma Rehabilitation Centers, enrolled in the VA TBI Model Systems parent study, and attending school during follow-up (N = 155). Outcome measures included the Functional Independence Measure (FIM), Neurobehavioral Symptom Inventory (NSI), Post-traumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C), Patient Health Questionnaire-Depression (PHQ-9), and Generalized Anxiety Disorder Questionnaire (GAD-7). Findings: Participants were mostly male (92.9%) and White (81.4%), with mild (40.0%), moderate (11.5%), severe (34.5%), or very severe TBI (23.0%). Depression, anxiety, PTSD, and postconcussion symptoms were lowest in participants with very severe TBI and highest in those with mild TBI. There were no significant differences in FIM across TBI severity levels. Conclusion: This study supports the need for rehabilitation counselors, educators, and administrators to prepare future practitioners to deliver tailored services to student V/M with TBI. These services can facilitate successful community reintegration and transition into civilian school settings. Symptom profiling may inform personalized cognitive interventions to enhance these students' academic success. [ABSTRACT FROM AUTHOR]