The impact of acute care medications on rehabilitation outcome after traumatic brain injury.
OBJECTIVE
To examine the impact of medications with known central nervous system (CNS) mechanisms of action, given during the acute care stages after traumatic brain injury (TBI), on the extent of cognitive and motor recovery during inpatient rehabilitation.


METHODS
Retrospective extraction of data utilizing an inception cohort of moderate and severe TBI survivors.


METHODS
The records of 182 consecutive moderate and severe TBI survivors admitted to a single, large, Midwestern level I trauma centre and subsequently transferred for acute inpatient rehabilitation were abstracted for the presence of 11 categories of medication, three measures of injury severity (worst 24 hour Glasgow Coma Scale, worst pupillary response, intra-cranial hypertension), three measures of outcome (Function Independence Measure (FIM) Motor and Cognitive scores at both rehabilitation admission and discharge and duration of post-traumatic amnesia (PTA)).


RESULTS
The narcotics, benzodiazepines and neuroleptics were the most common categories of CNS active medications (92%, 67% and 43%, respectively). The three categories of medications appeared to have no significant outcome on the FIM outcome variables. The neuroleptics affected cognitive recovery with almost 7 more days required to clear PTA in the neuroleptic treated group. The presence of benzodiazepines did tend to obscure the impact of neuroleptics on PTA duration but the negative impact of neuroleptics on PTA duration remained significant.


CONCLUSIONS
The results suggest that the use of neuroleptics during the acute care stage of recovery has a negative impact on recovery of cognitive function at discharge from inpatient rehabilitation. Due to the paucity of subjects with hemiplegia in this cohort, conclusions could not be drawn as to the impact of acute care medications on motor recovery.
Mysiw
W Jerry
WJ
Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH 43210, USA. mysiw.1@osu.edu
Bogner
Jennifer A
JA
Corrigan
John D
JD
Fugate
Lisa P
LP
Clinchot
Daniel M
DM
Kadyan
Vivek
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000534:rehabilitation*; D002491:Central Nervous System Agents / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced*; D015331:Cohort Studies; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000188:drug therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D002491:Central Nervous System Agents