Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury presented in part to the American congress of rehabilitation medicine, October 10, 2014, Toronto, ON, Canada.

Jennifer Bogner, Ryan S. Barrett, Flora Hammond, Susan D. Horn, John D. Corrigan, Joseph Rosenthal, Cynthia L. Beaulieu, Margaret Waszkiewicz, Timothy Shea, Christopher J. Reddin, Nora Cullen, Clare G. Giuffrida, James Young, William Garmoe

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)S274-S281e4
JournalArchives of Physical Medicine and Rehabilitation
Volume96
Issue number8
DOIs
StatePublished - Aug 1 2015

Fingerprint

Cognition
Canada
Inpatients
Rehabilitation
Medicine
Serotonin Receptor Agonists
Anti-Asthmatic Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Rehabilitation Centers
Sodium Channels
Anti-Anxiety Agents
Hypnotics and Sedatives
Anticonvulsants
gamma-Aminobutyric Acid
Antipsychotic Agents
Observational Studies
Longitudinal Studies
Dopamine
Norepinephrine
Outcome Assessment (Health Care)

Keywords

  • Brain injuries
  • Confusion
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury presented in part to the American congress of rehabilitation medicine, October 10, 2014, Toronto, ON, Canada. / Bogner, Jennifer; Barrett, Ryan S.; Hammond, Flora; Horn, Susan D.; Corrigan, John D.; Rosenthal, Joseph; Beaulieu, Cynthia L.; Waszkiewicz, Margaret; Shea, Timothy; Reddin, Christopher J.; Cullen, Nora; Giuffrida, Clare G.; Young, James; Garmoe, William.

In: Archives of Physical Medicine and Rehabilitation, Vol. 96, No. 8, 01.08.2015, p. S274-S281e4.

Research output: Contribution to journalArticle

Bogner, J, Barrett, RS, Hammond, F, Horn, SD, Corrigan, JD, Rosenthal, J, Beaulieu, CL, Waszkiewicz, M, Shea, T, Reddin, CJ, Cullen, N, Giuffrida, CG, Young, J & Garmoe, W 2015, 'Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury presented in part to the American congress of rehabilitation medicine, October 10, 2014, Toronto, ON, Canada.', Archives of Physical Medicine and Rehabilitation, vol. 96, no. 8, pp. S274-S281e4. https://doi.org/10.1016/j.apmr.2015.04.020
Bogner, Jennifer ; Barrett, Ryan S. ; Hammond, Flora ; Horn, Susan D. ; Corrigan, John D. ; Rosenthal, Joseph ; Beaulieu, Cynthia L. ; Waszkiewicz, Margaret ; Shea, Timothy ; Reddin, Christopher J. ; Cullen, Nora ; Giuffrida, Clare G. ; Young, James ; Garmoe, William. / Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury presented in part to the American congress of rehabilitation medicine, October 10, 2014, Toronto, ON, Canada. In: Archives of Physical Medicine and Rehabilitation. 2015 ; Vol. 96, No. 8. pp. S274-S281e4.
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abstract = "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.",
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AU - Horn, Susan D.

AU - Corrigan, John D.

AU - Rosenthal, Joseph

AU - Beaulieu, Cynthia L.

AU - Waszkiewicz, Margaret

AU - Shea, Timothy

AU - Reddin, Christopher J.

AU - Cullen, Nora

AU - Giuffrida, Clare G.

AU - Young, James

AU - Garmoe, William

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N2 - 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.

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