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- Title
Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?
- Authors
Blackmore, Christopher; Ouellet, Jean-Francois; Niven, Daniel; Kirkpatrick, Andrew W.; Ball, Chad G.
- Abstract
Background: Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophyl-axis in severely injured patients. Methods: We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients' medical records and the Alberta Trauma Registry. Results: Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophyl-axis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis. Conclusion: Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, stan-dard protocols for prophylaxis are essential.
- Subjects
DELIRIUM; WERNICKE'S encephalopathy; BLOOD alcohol analysis; VITAMIN B1; ALCOHOLISM; TRAUMATISM; PREVENTION
- Publication
Canadian Journal of Surgery, 2014, Vol 57, Issue 2, p78
- ISSN
0008-428X
- Publication type
Article
- DOI
10.1503/cjs.006413