Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness
Objective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arou...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-04-01
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| Series: | Frontiers in Surgery |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.627008/full |
| _version_ | 1818657530914537472 |
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| author | Zhe Wang Nathan J. Winans Nathan J. Winans Zirun Zhao Megan E. Cosgrove Theresa Gammel Jordan R. Saadon Racheed Mani Bharadwaj Ravi Susan M. Fiore Charles B. Mikell Sima Mofakham |
| author_facet | Zhe Wang Nathan J. Winans Nathan J. Winans Zirun Zhao Megan E. Cosgrove Theresa Gammel Jordan R. Saadon Racheed Mani Bharadwaj Ravi Susan M. Fiore Charles B. Mikell Sima Mofakham |
| author_sort | Zhe Wang |
| collection | DOAJ |
| description | Objective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arousal and is often among the first signs of neurological recovery. A better understanding of these behaviors may shed light on the mechanisms driving the return of consciousness in sTBI patients. This study aims to investigate the association between posttraumatic agitation and the recovery of consciousness.Methods: A retrospective chart review was conducted in 530 adult patients (29.1% female) admitted to Stony Brook University Hospital between January 2011 and December 2019 with a diagnosis of sTBI and Glasgow Coma Scale (GCS) ≤8. Agitation was defined as a Richmond Agitation Sedation Scale (RASS) > +1, or any documentation of equivalently combative and violent behaviors in daily clinical notes. The ability to follow verbal commands was used to define the recovery of consciousness and was assessed daily.Results: Of 530 total sTBI patients, 308 (58.1%) survived. Agitation was present in 169 of all patients and 162 (52.6%) of surviving patients. A total of 273 patients followed commands, and 159 of them developed agitation. Forty patients developed agitation on hospital arrival whereas 119 developed agitation later during their hospital course. Presence of in-hospital agitation positively correlated with command-following (r = 0.315, p < 0.001). The time to develop agitation and time to follow commands showed positive correlation (r = 0.485, p < 0.001). These two events occurred within 3 days in 54 (44.6%) patients, within 7 days in 81 (67.8%) patients, and within 14 days in 96 (80.2%) patients. In 71 (59.7%) patients, agitation developed before command-following; in 36 (30.2%) patients, agitation developed after command-following; in 12 (10.1%) patients, agitation developed on the same day as command-following.Conclusion: Posttraumatic agitation in comatose patients following sTBI is temporally associated with the recovery of consciousness. This behavior indicates the potential for recovery of higher neurological functioning. Further studies are required to identify neural correlates of posttraumatic agitation and recovery of consciousness after sTBI. |
| first_indexed | 2024-12-17T03:42:57Z |
| format | Article |
| id | doaj.art-1ed2500259794c14b9d17f9672694a9d |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-17T03:42:57Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-1ed2500259794c14b9d17f9672694a9d2022-12-21T22:04:58ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-04-01810.3389/fsurg.2021.627008627008Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of ConsciousnessZhe Wang0Nathan J. Winans1Nathan J. Winans2Zirun Zhao3Megan E. Cosgrove4Theresa Gammel5Jordan R. Saadon6Racheed Mani7Bharadwaj Ravi8Susan M. Fiore9Charles B. Mikell10Sima Mofakham11Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Columbia University Medical Center, New York, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurobiology and Behavior, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesDepartment of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United StatesObjective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arousal and is often among the first signs of neurological recovery. A better understanding of these behaviors may shed light on the mechanisms driving the return of consciousness in sTBI patients. This study aims to investigate the association between posttraumatic agitation and the recovery of consciousness.Methods: A retrospective chart review was conducted in 530 adult patients (29.1% female) admitted to Stony Brook University Hospital between January 2011 and December 2019 with a diagnosis of sTBI and Glasgow Coma Scale (GCS) ≤8. Agitation was defined as a Richmond Agitation Sedation Scale (RASS) > +1, or any documentation of equivalently combative and violent behaviors in daily clinical notes. The ability to follow verbal commands was used to define the recovery of consciousness and was assessed daily.Results: Of 530 total sTBI patients, 308 (58.1%) survived. Agitation was present in 169 of all patients and 162 (52.6%) of surviving patients. A total of 273 patients followed commands, and 159 of them developed agitation. Forty patients developed agitation on hospital arrival whereas 119 developed agitation later during their hospital course. Presence of in-hospital agitation positively correlated with command-following (r = 0.315, p < 0.001). The time to develop agitation and time to follow commands showed positive correlation (r = 0.485, p < 0.001). These two events occurred within 3 days in 54 (44.6%) patients, within 7 days in 81 (67.8%) patients, and within 14 days in 96 (80.2%) patients. In 71 (59.7%) patients, agitation developed before command-following; in 36 (30.2%) patients, agitation developed after command-following; in 12 (10.1%) patients, agitation developed on the same day as command-following.Conclusion: Posttraumatic agitation in comatose patients following sTBI is temporally associated with the recovery of consciousness. This behavior indicates the potential for recovery of higher neurological functioning. Further studies are required to identify neural correlates of posttraumatic agitation and recovery of consciousness after sTBI.https://www.frontiersin.org/articles/10.3389/fsurg.2021.627008/fullsevere traumatic brain injurycomaposttraumatic agitationrecovery of consciousnessantipsychotics |
| spellingShingle | Zhe Wang Nathan J. Winans Nathan J. Winans Zirun Zhao Megan E. Cosgrove Theresa Gammel Jordan R. Saadon Racheed Mani Bharadwaj Ravi Susan M. Fiore Charles B. Mikell Sima Mofakham Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness Frontiers in Surgery severe traumatic brain injury coma posttraumatic agitation recovery of consciousness antipsychotics |
| title | Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness |
| title_full | Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness |
| title_fullStr | Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness |
| title_full_unstemmed | Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness |
| title_short | Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness |
| title_sort | agitation following severe traumatic brain injury is a clinical sign of recovery of consciousness |
| topic | severe traumatic brain injury coma posttraumatic agitation recovery of consciousness antipsychotics |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2021.627008/full |
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