Article

OBJECTIVE: To assess the incidence of medical complications in patients with
recent traumatic disorders of consciousness (DOCs).
DESIGN: Data on adverse
events in a placebo controlled trial of amantadine hydrochloride revealed no
group difference, which allowed these events to be reanalyzed descriptively as
medical complications experienced by the 2 groups collectively. SETTING: Eleven
clinical facilities in the United States, Denmark, and Germany with specialty
rehabilitation programs for patients with DOCs. PARTICIPANTS: Patients (N=184)
with nonpenetrating traumatic brain injury enrolled from acute inpatient
rehabilitation programs between 4 and 16 weeks postinjury. INTERVENTIONS:
Participants were randomized to receive 200 to 400mg of amantadine hydrochloride
or placebo daily for 4 weeks, and followed for an additional 2 weeks. Adverse
events were recorded and categorized with respect to their nature, timing, and
severity. MAIN OUTCOME MEASURE: Number, type, and severity of medical
complications occurring during the 6-week study interval. RESULTS: A total of 468
medical complications were documented among the patients (.40 events per week per
patient). More than 80% of patients experienced at least 1 medical complication,
and 41 of these were defined as serious adverse events. New medical complications
declined over time in rehabilitation and were not dependent on time since injury.
Hypertonia, agitation/aggression, urinary tract infection, and sleep disturbance
were the most commonly reported problems. Hydrocephalus, pneumonia,
gastrointestinal problems, and paroxysmal sympathetic hyperactivity were the most
likely to be severe. CONCLUSIONS: Patients with DOCs have a high rate of medical
complications early after injury. Many of these complications require brain
injury expertise for optimal management. Active medical management appears to
contribute to the reduction in new complications. An optimal system of care for
DOC patients must provide expert medical management in the early weeks after
injury.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS