title: Predictors of Agitated Behavior During Inpatient Rehabilitation for Traumatic Brain Injury.
abstract: OBJECTIVE
  To identify predictors of the severity of agitated behavior during inpatient traumatic brain injury (TBI) rehabilitation.
  
  
  METHODS
  Prospective, longitudinal observational study.
  
  
  METHODS
  Inpatient rehabilitation centers.
  
  
  METHODS
  Consecutive patients enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI, who exhibited agitation during their stay (n=555, N=2130).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH. Electronic address: Jennifer.Bogner@osumc.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bogner
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, IN and Carolinas Rehabilitation, Charlotte, NC.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: John D
authors.initials: JD
authors.lastname: Corrigan
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Brooks Rehabilitation Hospital, Jacksonville, FL.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Beaulieu
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Margaret
authors.initials: M
authors.lastname: Waszkiewicz
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: Timothy
authors.initials: T
authors.lastname: Shea
authors.affiliation: Naval Medical Center, San Diego, CA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Reddin
authors.affiliation: Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Cullen
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Clare G
authors.initials: CG
authors.lastname: Giuffrida
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: James
authors.initials: J
authors.lastname: Young
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC.
authors.forename: William
authors.initials: W
authors.lastname: Garmoe
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000145:classification / Q000453:epidemiology* / Q000534:rehabilitation*; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007297:Inpatients / Q000706:statistics & numerical data; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000453:epidemiology*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Brain injuries; Confusion; Rehabilitation