Risk of delirium and impaired neurological outcome associated with delay in neurorehabilitation after acquired brain injury

INTRODUCTION Brain injury from haemorrhage, trauma, aneurysm and stroke is characterised by high mortality and impaired neurological outcome. In the OUTREACH study, the authors wanted to assess patient care from admission to intensive neuro rehabilitation to discharge. We hypothesised that early rehabilitation was beneficial to neurological outcome.

METHODS 180-day mortality and modified Rankin Scale (mRS) were primary end points. Secondary end points included length of stay, Glasgow Coma Scale (GCS) on admission, ventilator days, Simplified Acute Physiology Score (SAPS II/III) and serious adverse events.

RESULTS Sixty-seven patients were included. Mortality at 180 days was 17.91% and the median mRS score was four. Length of stay was 20.89 ± 12.33 days. GCS at admittance was 13 (3-15). The average SAPS II/III score was 55.72 ± 20.03. Twenty-eight patients suffered from serious adverse events. In all, 47 patients waited for transfer to another facility for an average of 7.77 ± 6.08 days. For mRS, the linear model indicated a negative effect of waiting time (effect = –0.056 (95% confidence interval (CI): –0.117-0.004); p = 0.07). Risk of delirium was significantly affected by waiting time; an additional day of waiting increased the risk of delirium by 13.4% (odds ratio = 1.134 (95% CI: 1.028-1.252); p = 0.01).

CONCLUSIONS In this study, mortality and neurological outcome were comparable with those reported in similar studies. Waiting for transfer to another facility due to capacity significantly impairs neurological outcome and increases delirium.

FUNDING none.

TRIAL REGISTRATION not relevant