Acute Isolated Diastolic Hypotension and History of Substance Abuse in the Development of Delirium

ABSTRACT

INTRODUCTION: In a prior analysis, delirium was seen more often in patients with at least one incident of IDH in the first 48 hours compared to those who remained normotensive (8.1 vs 3.0%). Here we explored events over the entire hospital stay and focused on a subpopulation of patients with a history of substance abuse (SA). Their treatment would include a narcotic or benzodiazepine, as potential vasodilators they could increase the likelihood of IDH. METHOD(S) We performed Aa retrospective chart review of patients >18 years with blunt trauma, Glascow Coma Scale >= 14 and head/neck Abbreviated Injury Score <= 1 admitted to our Level I trauma center from 8/1/16 to 4/1/20, to avoid potential confounding from COVID-19., was doneperformed. This study focused on two groups normotensive (systolic blood pressure (SBP) >100 and diastolic blood pressure (DBP) >60) throughout their stay and IDH (SBP > 100 and DBP < 60) at any point during their admission. We compared them these two groups on the occurrence of delirium after an IDH episode using. The statistical comparisons were done using chi-square tests and logistic regressions, which included other patient characteristics associated with IDH and delirium. RESULT(S) A total of 1656 patients met inclusion criteria and were assessed for delirium (613 normotensive and 1043 IDH). As hypothesized, delirium was significantly more likely in the IDH than in the normotensive group (5.1 vs 1.5%;p < 0.001). As predicted patients with SA history were more likely to have IDH (62.2 vs 56.0%) and were more likely to develop delirium (6.2% vs. 3.4%) although these differences were not statistically significant. The IDH effect on delirium was significant only for patients without SA history and SA history was significant for delirium only in the normotensive group (both p <.0.001). The effect of IDH and its interaction with SA remained significant in multivariate analysis. Age also remained an independent risk factor for delirium. CONCLUSION(S) These results confirm our prior work on the association of IDH and delirium and suggest that SA has an impact on IDH. Surprisingly, these two factors do not appear to compound each other. This pattern remains significant in a multivariate approach. More exploration of the interaction of substance abuse on IDH and other factors is needed.