Behavioural problems in the first year after Severe traumatic brain injury: a prospective multicentre study.
OBJECTIVE
To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff.


METHODS
In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury.


METHODS
Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended.


RESULTS
Agitation were most common at 3 weeks post injury and 28% ( n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% ( n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year.


CONCLUSIONS
Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.
1 Department of Clinical Sciences, Karolinska Institutet, and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, SE-182 88 Stockholm, Sweden.
Catharina
C
Nygren DeBoussard
2 Sandviken Hospital and Uppsala University, Sweden.|3 Centre for Research and Development, Uppsala University/County Council of Gävleborg Gävle, Sweden.
Marianne
M
Lannsjö
4 Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
Maud
M
Stenberg
4 Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
Britt-Marie
BM
Stålnacke
1 Department of Clinical Sciences, Karolinska Institutet, and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, SE-182 88 Stockholm, Sweden.|5 Formerly of Department of Rehabilitation Medicine, University Hospital Uppsala and Uppsala University, Sweden.
Alison K
AK
Godbolt
D000293:Adolescent; D000328:Adult; D000368:Aged; D057565:Apathy; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D000066553:Problem Behavior / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D055815:Young Adult
Severe traumatic brain injury; agitation; assessment; behaviour; outcome; prognosis