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Post-traumatic Confusional State: A Case Definition and Diagnostic Criteria.
Mark Sherer1, Douglas I Katz2, Yelena G Bodien3
1TIRR Memorial Hermann, Houston, Texas.
Archives of Physical Medicine and Rehabilitation
|August 2, 2020
Summary
New criteria define the posttraumatic confusional state (PTCS) following brain injury. This helps understand emerging consciousness and differentiate PTCS from other conditions.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Psychiatry
Background:
- Traumatic brain injury (TBI) can impair consciousness, leading to conditions like posttraumatic amnesia.
- A clear definition of emerging consciousness after TBI is needed to guide clinical practice and research.
Purpose of the Study:
- To develop a case definition and diagnostic criteria for the posttraumatic confusional state (PTCS).
- To delineate the natural history of consciousness recovery after TBI.
Main Methods:
- An exhaustive literature review of 2466 abstracts and 44 articles.
- Expert consensus from a multidisciplinary workgroup using modified Delphi voting.
- Development of detailed criteria including core and associated neurobehavioral features, functional implications, and exclusion criteria.
Main Results:
- A comprehensive case definition for PTCS was established.
- Core features include attention, orientation, and memory disturbances with fluctuation.
- Associated features encompass emotional, behavioral, and perceptual disturbances, with clear lower and upper boundaries for emergence.
Conclusions:
- The developed criteria provide a framework for identifying and studying PTCS.
- Further research aims to establish assessment cutoffs and behavioral function levels to distinguish PTCS from recovery states.
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