title: Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes.
abstract: BACKGROUND
  Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study.
  
  
  METHODS
  We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton IADL (Instrumental Activities of Daily Living) scores. Independent predictors were identified using logistic regression.
  
  
  RESULTS
  From 309 SAH patients admitted between January 2011 and December 2015, 52 (17 %) developed agitation, frequently in the first 72 h (50 %) and in patients with Hunt-Hess grades 3-4 (12 % of grades 1-2, 28 % of grades 3-4, 8 % of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications; and in half of these patients, complications were diagnosed within 24 h of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95 % CI, 1.1-6.8) in non-comatose patients (Hunt-Hess 1-4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors.
  
  
  CONCLUSIONS
  Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications and may have an independent impact on long-term outcomes.
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Reznik
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mahta
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Roh
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: Soojin
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA.
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Frey
authors.affiliation: Department of Critical Care Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8-300, New York, NY, 10032, USA. jc1439@cumc.columbia.edu.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000453:epidemiology / Q000628:therapy
chemical_list: D014150:Antipsychotic Agents
keywords: Agitation; Brain injury; Delirium; Stroke; Subarachnoid hemorrhage