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Confusion (Delirium) Appears Common among Individuals in Inpatient Rehabilitation

Categories: Cognition - Thinking and Emotional Skills

The Question

How common is extreme confusion (delirium) among individuals with traumatic brain injury in inpatient rehabilitation?

Past Studies

Past Studies show that individuals who lose consciousness with a traumatic brain injury can experience a brief or prolonged period of altered mental abilities as they regain alertness and recover. During this state, individuals may have difficulty with thinking skills such as memory and disorientation. Difficulty with attention, mood swings, and behavior problems are also common. To date, this period had been termed “post-traumatic amnesia” specifically because of its characteristic loss of memory skills and disorientation. More recently, researchers have argued that problems keeping an attention span are more common and that this recovery period has characteristics similar to delirium. Delirium is an acute confusional disorder that can occur after the loss of consciousness or medical condition. Symptoms of delirium include problems with attention span, remaining awake, thinking, and inconsistency in abilities over time. Other features can include altered activity levels, psychotic symptoms (hallucinations, delusions), and mood swings. Because of this, recent researchers suggest using the term “post-traumatic confusional state” instead of post-traumatic amnesia. However, most studies about delirium have not included individuals with traumatic brain injury.

This Study

This study evaluated 85 individuals from one inpatient rehabilitation facility for symptoms of delirium. The individuals had mild, moderate, and severe traumatic brain injuries. The researchers reviewed the participants’ medical records and conducted interviews with them and their families. The researchers tested the participants weekly using standardized tests of delirium and post-traumatic amnesia and clinical interview. Participants were diagnosed using widely accepted diagnostic guidelines for delirium (the American Psychiatric Association’s DSM-IV criteria). Fifty-nine (69%) of the 85 participants met the criteria for delirium at the time of inpatient admission. Of these 59, 42 (71%) recovered from delirium during inpatient rehabilitation. The post-traumatic confusional state appeared average 43 days among participants in this study. Overall, this group of individuals with traumatic brain injury had a higher incidence of delirium than reported in prior studies of individuals with other medical conditions (69% vs. 20%) which typically included older individuals.

Who May Be Affected By These Findings

Individuals with traumatic brain injury and their loved ones, health care personnel, insurers, and researchers.


The researchers argue that the standardized testing measures for post-traumatic amnesia alone do not capture all of the symptoms of the delirium. They state that the characteristics of post-traumatic confusion (delirium) must be identified for the individual to receive the most appropriate treatments and best outcomes.

Bottom Line

Delirium appears common among individuals with traumatic brain injury in inpatient rehabilitation. Sixty-nine percent of the individuals in this study met the criteria for delirium at the time of admission to inpatient rehabilitation. This rate is significantly higher than reported for individuals with other medical diagnoses in prior studies which typically included older individuals.

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Find This Study

Nakase-Thompson, R., Sherer, M., Yablon, S., Nick, T.G., & Trzepacz, P.T. (2004). Acute confusion following traumatic brain injury.Brain Injury, 18, 131-142.


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