Journal article
Decreased Risk of Delirium With Use of Regional Analgesia in Geriatric Trauma Patients With Multiple Rib Fractures
Annals of surgery, v 268(3), pp 534-540
Sep 2018
PMID: 30048325
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The aim of this study was to examine the risk of delirium in geriatric trauma patients with rib fractures treated with systemic opioids compared with those treated with regional analgesia (RA).
Delirium is a modifiable complication associated with increased morbidity and mortality. RA may reduce the need for opioid medications, which are associated with delirium in older adults.
Cohort study of patients ≥65 years admitted to a regional trauma center from 2011 to 2016. Inclusion factors were ≥ 3 rib fractures, blunt trauma mechanism, and admission to intensive care unit (ICU). Exclusion criteria included head AIS ≥3, spine AIS ≥3, dementia, and death within 24 hours. The primary outcome was delirium positive ICU days, defined using the CAM-ICU assessment. Delirium incident rate ratios (IRRs) and 95% confidence intervals (95% CIs) were estimated using generalized linear mixed models with Poisson distribution and robust standard errors.
Of the 144 patients included in the study, 27 (19%) received Acute Pain Service consultation and RA and 117 (81%) received opioid-based systemic analgesia. Patients with RA had more severe chest injury than those without. The risk of delirium decreased by 24% per day per patient with use of RA (IRR 0.76, 95% CI 0.61 to 0.96). Individual opioid use, as measured in daily morphine equivalents (MEDs), was significantly reduced after initiation of RA (mean difference -7.62, 95% CI -14.4 to -0.81).
Although use of RA techniques in geriatric trauma patients with multiple rib fractures was associated with higher MED, opioid use decreased after RA initiation and Acute Pain Service consultation, and the risk of delirium was lower.
Metrics
Details
- Title
- Decreased Risk of Delirium With Use of Regional Analgesia in Geriatric Trauma Patients With Multiple Rib Fractures
- Creators
- Kathleen M O'Connell - University of WashingtonD Alex Quistberg - Drexel UniversityRobert Tessler - Department of Surgery, University of Washington, Seattle, WABryce R H Robinson - University of WashingtonJoseph Cuschieri - University of WashingtonRonald V Maier - University of WashingtonFrederick P Rivara - University of WashingtonMonica S Vavilala - University of WashingtonPaul I Bhalla - University of WashingtonSaman Arbabi - University of Washington
- Publication Details
- Annals of surgery, v 268(3), pp 534-540
- Publisher
- Lippincott
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative
- Web of Science ID
- WOS:000442240600016
- Scopus ID
- 2-s2.0-85060952641
- Other Identifier
- 991019168695804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery