Delirium following traumatic brain injury in adolescents: Symptomatology and prediction of ability to return to school or employment 1‐year post‐injury

Background There is a limited evidence‐base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, or the degree to which delirium impacts the ability of adolescents to return to school or work. Objective To describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability 1 year post‐injury was also examined. Design Exploratory secondary analysis of prospectively collected data. Setting Free‐standing rehabilitation hospital. Patients Severely injured TBI Model Systems neurorehabilitation admissions (n = 243; median Glasgow Coma Scale = 7). The sample was divided into three age groups (adolescents, 16–21 years, n = 63; adults 22–49 years, n = 133; older adults ≥50 years, n = 47). Interventions Not applicable. Measures We assessed patients using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) diagnostic criteria and the Delirium Rating Scale‐Revised 98 (DRS‐R‐98). The employability item from the Disability Rating Scale was the primary 1‐year outcome. Results Most items on the DRS‐R‐98 differentiated delirious from non‐delirious adolescents. Only “delusions” differed among age groups. Among adolescents, delirium status 1 month post‐TBI provided acceptable classification of employability prediction 1 year later (area under the curve [AUC]: 0.80, 95% confidence interval [CI]: 0.69–0.91, p