Risk of Delirium and Use of Regional Analgesia in Geriatric Trauma Patients with Multiple Rib Fractures

Abstract

Objective: To examine the risk of delirium in geriatric trauma patients with rib fractures treated with systemic opioids alone compared to those treated with regional analgesia (RA). Methods: Cohort study of patients ≥ 65 years with ≥ 3 rib fractures admitted to Harborview Medical Center from 2011-2016. The primary outcome was delirium positive ICU days. Risk of delirium was estimated using generalized linear mixed models with Poisson distribution and robust standard errors. Results: The incidence of delirium in the No RA group was 26% compared to 59% in the RA group. Risk of delirium was 19% higher on ICU day #1 compared to the No RA group (IRR 1.19, 95% CI 0.01, 3.94), and remained higher on ICU day #7 (IRR 1.14, 95% CI 1.02, 1.27). Conclusions: Limitations of this study prevent clear interpretation of the results, and further studies are needed to assess the association of delirium and RA in geriatric patients with multiple rib fractures.