Agitation and restlessness after closed head injury: a prospective study of 100 consecutive admissions

Agitation and restlessness are two of the most striking and problematic behaviors for patients with traumatic brain injury (TBI), their caregivers, and their families. These behaviors are often treated with physical and chemical restraints which have potentially harmful side effects. There are, however, few prospective studies which clearly define agitation and restlessness in a representative sample of TBI patients. Subjects for this study were 100 consecutive patients with traumatic, closed head injury (CHI) admitted to a regional Level I Trauma Center with a Glasgow Coma Scale score of less than 8, who had more than one hour of coma, and who required more than one week of hospitalization. Agitation was defined as episodic motor or verbal behavior which interfered with patient care or clearly required physical or chemical restraints to prevent damage to persons or property. This variable was rated on the Overt Aggression Scale, a 16-item scale, in four categories: verbal aggression; physical aggression against objects; physical aggression against self; or physical aggression directed at others. Systematic direct observations, caregiver interviews, and chart reviews were used to determine the frequency and duration of agitation. Patients were also monitored for restlessness, which was defined as behavior that interfered with staff or required some action by staff, such as change of activity, but either did not meet the severity criteria for agitation, or was continuous. Only 11 of the 100 subjects exhibited episodic agitation which met the criteria. Eight subjects were agitated for one week, one for two weeks, one for three weeks, and one for four weeks. Only one subject went directly from being unresponsive to being agitated.(ABSTRACT TRUNCATED AT 250 WORDS)