title: Polypharmacy and the use of medications in inpatients with acquired brain injury during post-acute rehabilitation: A cross-sectional study.
abstract: BACKGROUND
  This study assessed the use of medications during inpatient post-acute rehabilitation for acquired brain injury (ABI).
  
  
  METHODS
  All inpatients with ABI undergoing post-acute rehabilitation in centres identified through the roster of the Italian Society for Rehabilitation Medicine were included. A designated physician in each centre collected information through a structured questionnaire. This study calculated (a) prevalence of medication use, (b) logistic regression Odds Ratio (OR), with 95% confidence interval (95% CI), of polypharmacy (≥ 6 medications).
  
  
  RESULTS
  A total of 484 patients (median age = 52 years, 63.4% men, median time from acute event = 18.5 weeks) were included; 33.8% had Rancho Los Amigos Levels of Cognitive Functioning Scale (RLAS) score 1-2, 8.1% had a score of 7-8, of whom 92.0% received medications, 51.8% had a score of 6-10, of whom 83.9% had at least one psychotropic medication and 66.9% had two or more; 51.8% received anti-epileptics, 32.1% anti-depressants, 14.5% anti-psychotics, peaking in RLAS 4 (37.3%) and decreasing in RLAS 7-8. Polypharmacy was directly associated with age (55-64 years, OR = 2.1; 95% CI = 1.1-4.1; ≥ 65 years, OR = 1.7; 95% CI = 0.9-3.3), inversely with RLAS score (1-2 vs 7-8, OR = 4.3; 95% CI = 1.9-9.8).
  
  
  CONCLUSIONS
  Polypharmacy and concurrent use of psychotropic medications was common, raising concern about drug-drug interactions. Safety and effectiveness of medications should be monitored, particularly when used concurrently.
authors.affiliation: a Institute of Hygiene and Epidemiology, Department of Biological and Medical Sciences , University of Udine , Udine , Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Cosano
authors.affiliation: a Institute of Hygiene and Epidemiology, Department of Biological and Medical Sciences , University of Udine , Udine , Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Giangreco
authors.affiliation: b Institute of Hygiene and Clinical Epidemiology , University Hospital of Udine , Udine , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ussai
authors.affiliation: c Unit for the Rehabilitation of Acquired Neuropsychological Disturbances , Institute of Rehabilitation and Physical Medicine , Gervasutta Hospital , Udine , Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Giorgini
authors.affiliation: c Unit for the Rehabilitation of Acquired Neuropsychological Disturbances , Institute of Rehabilitation and Physical Medicine , Gervasutta Hospital , Udine , Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Biasutti
authors.affiliation: a Institute of Hygiene and Epidemiology, Department of Biological and Medical Sciences , University of Udine , Udine , Italy.|b Institute of Hygiene and Clinical Epidemiology , University Hospital of Udine , Udine , Italy.|d Department of Medicine , University of Trieste , Trieste , Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barbone
authors.affiliation: b Institute of Hygiene and Clinical Epidemiology , University Hospital of Udine , Udine , Italy.
authors.forename: Federica Edith
authors.initials: FE
authors.lastname: Pisa
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000188:drug therapy* / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D007558:Italy; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D012047:Rehabilitation Centers
chemical_list: D011619:Psychotropic Drugs
keywords: ABI; brain injury; polypharmacy; post-acute rehabilitation; psychotropic