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

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.