Predictors of Agitated Behavior During Inpatient Rehabilitation for Traumatic Brain Injury.

Autor:	Bogner J; Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH. Electronic address: Jennifer.Bogner@osumc.edu., Barrett RS; Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT., Hammond FM; Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, IN and Carolinas Rehabilitation, Charlotte, NC., Horn SD; Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT., Corrigan JD; Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH., Rosenthal J; Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH., Beaulieu CL; Brooks Rehabilitation Hospital, Jacksonville, FL., Waszkiewicz M; Rush University Medical Center, Chicago, IL., Shea T; Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH., Reddin CJ; Naval Medical Center, San Diego, CA., Cullen N; Toronto Rehabilitation Institute, Toronto, ON, Canada., Giuffrida CG; Rush University Medical Center, Chicago, IL., Young J; Rush University Medical Center, Chicago, IL., Garmoe W; MedStar National Rehabilitation Hospital, Washington, DC.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2015 Aug; Vol. 96 (8 Suppl), pp. S274-81.e4.
DOI:	10.1016/j.apmr.2015.04.020
Abstrakt:	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. (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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