Article

OBJECTIVE: To identify predictors of the severity of agitated behavior during
inpatient traumatic brain injury (TBI) rehabilitation.
DESIGN: Prospective,
longitudinal observational study. SETTING: Inpatient rehabilitation centers.
PARTICIPANTS: Consecutive patients enrolled between 2008 and 2011, admitted for
inpatient rehabilitation after index TBI, who exhibited agitation during their
stay (n=555, N=2130). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE:
Daytime Agitated Behavior Scale scores. RESULTS: Infection and lower FIM
cognitive scores predicted more severe agitation. The medication classes
associated with more severe agitation included sodium channel antagonist
anticonvulsants, second-generation antipsychotics, and gamma-aminobutyric acid-A
anxiolytics/hypnotics. Medication classes associated with less severe agitation
included antiasthmatics, statins, and norepinephrine-dopamine-5 hydroxytryptamine
(serotonin) agonist stimulants. CONCLUSIONS: Further support is provided for the
importance of careful serial monitoring of both agitation and cognition to
provide early indicators of possible beneficial or adverse effects of
pharmacologic interventions used for any purpose and for giving careful
consideration to the effects of any intervention on underlying cognition when
attempting to control agitation. Cognitive functioning was found to predict
agitation, medications that have been found in previous studies to enhance
cognition were associated with less agitation, and medications that can
potentially suppress cognition were associated with more agitation. There could
be factors other than the interventions that account for these relations. In
addition, the study provides support for treatment of underlying disorders as a
possible first step in management of agitation. Although the results of this
study cannot be used to draw causal inferences, the associations that were found
can be used to generate hypotheses about the most viable interventions that
should be tested in future controlled trials.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS