Psychotropic Medication Use During Inpatient Rehabilitation for Traumatic Brain Injury

Abstract

Objective To describe psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and their relationship to patient pre-injury and injury characteristics. Design Prospective observational cohort. Setting multiple acute inpatient rehabilitation units or hospitals. Participants 2,130 individuals with TBI (complicated mild, moderate, or severe) admitted for inpatient rehabilitation. Interventions NA Main Outcome Measure(s) NA Results Most frequently administered was narcotic analgesics (72% of sample) followed by antidepressants (67%), anticonvulsants (47%), antianxiolytics (33%), hypnotics (30%), stimulants (28%), antipsychotics (25%), antiparkinson agents (25%), and miscellaneous psychotropics (18%). The psychotropic agents studied were administered to 95% of the sample with 8.5% receiving only 1 and 31.8% receiving 6 or more. Degree of psychotropic medication administration varied widely between sites. Univariate analyses indicated younger patients were more likely to receive anxiolytics, antidepressants, antiparkinson agents, stimulants, antipsychotics, and narcotic analgesics, while those older were more likely to receive anticonvulsants and miscellaneous psychotropics. Men were more likely to receive antipsychotics. All medication classes were less likely administered to Asians, and more likely to those with more severe functional impairment. Use of anticonvulsants was associated with having seizures at some point during acute care or rehabilitation stays. Narcotic analgesics were more likely for those with history of drug abuse, history of anxiety and depression (premorbid or during acute care), and severe pain during rehabilitation. Psychotropic medication administration increased rather than decreased during the course of inpatient rehabilitation in each of the medication categories except for narcotics. This observation was also true for medication administration within admission functional levels (defined by cognitive Functional Independence Measure (FIM) scores), except for those with higher admission cognitive FIM scores. Conclusion(s) Many psychotropic medications are used during inpatient rehabilitation. In general, lower admission FIM Cognitive groups were administered more of the medications under investigation, compared to those with higher cognitive function at admission. Considerable site variation existed regarding medications administered. The current investigation provides baseline data for future studies of effectiveness.

Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and 9 Months Postdischarge

“…More detailed information on medication prevalence and use patterns in this sample is presented elsewhere. 18 Because of the large number of therapy activities, some collapsing was necessary so that models were not over-specified. OT, PT, and ST activity collapses can be found in detail elsewhere.…”

“…Covariates were allowed to enter and be added into each model in one of five blocks: (1) patient and injury characteristics, (2) discipline-specific total minutes/week, (3) percent of stay on medications from each of 8 pharmacological classes (defined elsewhere), 18 (4) level of effort (LOE), (5) discipline-specific activity minutes/week, and (6) centers participating in the study. We computed the amount of variation explained when we allowed various combinations of the variable blocks to enter models predicting outcomes.…”

“…15 Other articles in this series have documented the nature, scope, and variation of TBI rehabilitation practice as observed in this study, 16–18 which was designed to identify associations among TBI rehabilitation patient and injury characteristics, therapeutic processes, and outcomes. 15 Clinicians and researchers defined granular details of the care rendered.…”

Pharmacological interventions for agitation in patients with traumatic brain injury: protocol for a systematic review and meta-analysis

“…In acutely ill patients, one recent single-centre study ( n  = 195 patients) reported antipsychotic use in 26.7% of patients within 7 days of TBI [26]. In a recent observational study of 10 North American inpatient rehabilitation facilities, antidepressants, anticonvulsants, stimulants, and antipsychotics were used for the management of neurobehavioral complications of TBI in 67%, 47%, 28%, and 25% of patients, respectively [27]. In addition, surveys have suggested wide variations in practice patterns in regard to the choice of agents to treat neurobehavioral problems [24, 28].…”

“…As post-traumatic agitation is a complex and poorly understood complication, occurring in a heterogeneous patient population, pharmacological interventions are inadequately studied despite the frequent use of various medications [27, 28]. Given the desired impact on the resolution of agitation while limiting potential adverse effects associated with the use of these agents in the TBI population, an analysis of the literature evaluating their efficacy and safety is imperative.…”