Aripiprazole in Delirium in Children and Adolescents After Traumatic Brain Injury—A Two-Patient Case Series and Structured Literature Review

Background: Traumatic brain injury (TBI) is a major public health concern and is frequently associated with delirium, particularly in critically ill patients. Evidence on pharmacological management of paediatric delirium is limited, and data on the use of atypical antipsychotics in children are scarce. Methods: We present a retrospective case series of two paediatric patients who developed hyperactive delirium following TBI. Both were initially treated with quetiapine. Due to insufficient clinical response, aripiprazole was added to the treatment regimen. In addition, a literature review examined aripiprazole for established delirium, agitation, or acute confusional states following TBI, with the broader delirium literature discussed for context. Results: In both cases, improvement in agitation and associated neurobehavioural symptoms was observed after aripiprazole was added. The focused literature search identified one eligible adult case report that described symptom improvement but also recurrent hypothermia leading to aripiprazole discontinuation. Evidence in paediatric patients remains sparse. Conclusions: These cases support further investigation of adjunctive aripiprazole for severe manifestations compatible with hyperactive delirium after paediatric TBI. Its individual contribution to improvement cannot be determined, and controlled studies are required before recommendations for routine clinical use can be made.