A descriptive analysis of pharmacological management of aggression and/or agitation in patients with traumatic brain injury in a Southwest Virginia inpatient population
What Is Known and Objective Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In a previous study, we reviewed the literature to identify evidence‐based pharmacological agents for treatment of agitation in TBI. Based on the results...
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| Veröffentlicht in: | Journal of clinical pharmacy and therapeutics 2022-12, Vol.47 (12), p.2083-2090 |
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| creator | Rahmani, Elham Lemelle, Tricia Sharp, Hunter Smarbafzadeh, Ehsan Kablinger, Anita |
| description | What Is Known and Objective
Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In a previous study, we reviewed the literature to identify evidence‐based pharmacological agents for treatment of agitation in TBI. Based on the results of our previous study that summarizes the findings of several systematic reviews, the use of haloperidol and benzodiazepines is not supported by the available evidence while the use of amantadine, beta blockers, antiepileptics and methylphenidate is supported by the limited available evidence. In this study, we describe the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in southwest Virginia. We will also compare the psycho‐pharmacological agents ordered before and after psychiatric consultation.
Methods
Adult patients who were admitted to Carilion Clinic's inpatient facilities from March 30, 2013, to March 30, 2018, had a diagnosis of TBI, and received psychiatric consultation for agitation and/or aggression were enrolled in this study. A retrospective review of electronic medical records was conducted by researchers and data were collected on the following measures: ordered psycho‐pharmacological agents, frequency, dosing and duration of orders, whether each administered psycho‐pharmacological agent was started before or after psychiatric consultation, and psycho‐pharmacological agents prescribed upon discharge.
Results and Discussion
About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence such as amantadine, beta blockers or antiepileptics. The percentage of patient‐days with an order to receive typical antipsychotics significantly decreased following psychiatric consultation (p = 0.0056), but the percentage of patient‐days with an order to receive benzodiazepines significantly increased following psychiatric consultation (p = 0.0001). This finding remained statistically significant after excluding patients with active or unclear alcohol/benzodiazepine withdrawal (p |
| doi_str_mv | 10.1111/jcpt.13754 |
| format | Article |
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Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In a previous study, we reviewed the literature to identify evidence‐based pharmacological agents for treatment of agitation in TBI. Based on the results of our previous study that summarizes the findings of several systematic reviews, the use of haloperidol and benzodiazepines is not supported by the available evidence while the use of amantadine, beta blockers, antiepileptics and methylphenidate is supported by the limited available evidence. In this study, we describe the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in southwest Virginia. We will also compare the psycho‐pharmacological agents ordered before and after psychiatric consultation.
Methods
Adult patients who were admitted to Carilion Clinic's inpatient facilities from March 30, 2013, to March 30, 2018, had a diagnosis of TBI, and received psychiatric consultation for agitation and/or aggression were enrolled in this study. A retrospective review of electronic medical records was conducted by researchers and data were collected on the following measures: ordered psycho‐pharmacological agents, frequency, dosing and duration of orders, whether each administered psycho‐pharmacological agent was started before or after psychiatric consultation, and psycho‐pharmacological agents prescribed upon discharge.
Results and Discussion
About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence such as amantadine, beta blockers or antiepileptics. The percentage of patient‐days with an order to receive typical antipsychotics significantly decreased following psychiatric consultation (p = 0.0056), but the percentage of patient‐days with an order to receive benzodiazepines significantly increased following psychiatric consultation (p = 0.0001). This finding remained statistically significant after excluding patients with active or unclear alcohol/benzodiazepine withdrawal (p < 0.0001).
What Is New and Conclusion
This study demonstrates the widespread use of typical antipsychotics and benzodiazepines in the management of agitation in TBI and the importance of multidisciplinary collaboration, research and education of providers to improve patient care.
Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In this study, we examined the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in Southwest Virginia. About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence. Percentage of patients who received each group of psycho‐pharmacological agents. Non‐recommended = Patients who received benzodiazepines OR typical antipsychotics. Recommended = Patients who received amantadine OR beta blockers (propranolol and pindolol) OR methylphenidate OR valproic acid OR carbamazepine. Atypical antipsychotics = Patients who received atypical antipsychotics that can be considered an acceptable alternative for management of acute agitation in TBI based on available evidence. Multiple medication groups = Patients who received all mentioned medication groups. Did not receive = Patients who did not receive any of the medications of interest.</description><identifier>ISSN: 0269-4727</identifier><identifier>EISSN: 1365-2710</identifier><identifier>DOI: 10.1111/jcpt.13754</identifier><identifier>PMID: 36543254</identifier><language>eng</language><publisher>England: Hindawi Limited</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Adult ; Aggression ; Aggression - psychology ; Agitation ; Amantadine ; Amantadine - therapeutic use ; Anticonvulsants - therapeutic use ; Antipsychotic Agents - therapeutic use ; Antipsychotics ; Benzodiazepines ; Benzodiazepines - therapeutic use ; Beta blockers ; Brain Injuries, Traumatic - complications ; Brain Injuries, Traumatic - drug therapy ; Electronic medical records ; Haloperidol ; Humans ; Inpatients ; Methylphenidate ; Original ; Patients ; Psychomotor Agitation - drug therapy ; Psychomotor Agitation - etiology ; Psychotropic drugs ; Statistical analysis ; Traumatic brain injury ; Virginia ; Withdrawal</subject><ispartof>Journal of clinical pharmacy and therapeutics, 2022-12, Vol.47 (12), p.2083-2090</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2022 The Authors. Journal of Clinical Pharmacy and Therapeutics published by John Wiley & Sons Ltd.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4494-a0068afae1d969a1bec5e922ed4d3e39e3b45912e34491bb956f37d8b1c5ef9e3</citedby><cites>FETCH-LOGICAL-c4494-a0068afae1d969a1bec5e922ed4d3e39e3b45912e34491bb956f37d8b1c5ef9e3</cites><orcidid>0000-0002-5246-9965</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjcpt.13754$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjcpt.13754$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36543254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rahmani, Elham</creatorcontrib><creatorcontrib>Lemelle, Tricia</creatorcontrib><creatorcontrib>Sharp, Hunter</creatorcontrib><creatorcontrib>Smarbafzadeh, Ehsan</creatorcontrib><creatorcontrib>Kablinger, Anita</creatorcontrib><title>A descriptive analysis of pharmacological management of aggression and/or agitation in patients with traumatic brain injury in a Southwest Virginia inpatient population</title><title>Journal of clinical pharmacy and therapeutics</title><addtitle>J Clin Pharm Ther</addtitle><description>What Is Known and Objective
Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In a previous study, we reviewed the literature to identify evidence‐based pharmacological agents for treatment of agitation in TBI. Based on the results of our previous study that summarizes the findings of several systematic reviews, the use of haloperidol and benzodiazepines is not supported by the available evidence while the use of amantadine, beta blockers, antiepileptics and methylphenidate is supported by the limited available evidence. In this study, we describe the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in southwest Virginia. We will also compare the psycho‐pharmacological agents ordered before and after psychiatric consultation.
Methods
Adult patients who were admitted to Carilion Clinic's inpatient facilities from March 30, 2013, to March 30, 2018, had a diagnosis of TBI, and received psychiatric consultation for agitation and/or aggression were enrolled in this study. A retrospective review of electronic medical records was conducted by researchers and data were collected on the following measures: ordered psycho‐pharmacological agents, frequency, dosing and duration of orders, whether each administered psycho‐pharmacological agent was started before or after psychiatric consultation, and psycho‐pharmacological agents prescribed upon discharge.
Results and Discussion
About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence such as amantadine, beta blockers or antiepileptics. The percentage of patient‐days with an order to receive typical antipsychotics significantly decreased following psychiatric consultation (p = 0.0056), but the percentage of patient‐days with an order to receive benzodiazepines significantly increased following psychiatric consultation (p = 0.0001). This finding remained statistically significant after excluding patients with active or unclear alcohol/benzodiazepine withdrawal (p < 0.0001).
What Is New and Conclusion
This study demonstrates the widespread use of typical antipsychotics and benzodiazepines in the management of agitation in TBI and the importance of multidisciplinary collaboration, research and education of providers to improve patient care.
Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In this study, we examined the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in Southwest Virginia. About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence. Percentage of patients who received each group of psycho‐pharmacological agents. Non‐recommended = Patients who received benzodiazepines OR typical antipsychotics. Recommended = Patients who received amantadine OR beta blockers (propranolol and pindolol) OR methylphenidate OR valproic acid OR carbamazepine. Atypical antipsychotics = Patients who received atypical antipsychotics that can be considered an acceptable alternative for management of acute agitation in TBI based on available evidence. Multiple medication groups = Patients who received all mentioned medication groups. Did not receive = Patients who did not receive any of the medications of interest.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Adult</subject><subject>Aggression</subject><subject>Aggression - psychology</subject><subject>Agitation</subject><subject>Amantadine</subject><subject>Amantadine - therapeutic use</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Antipsychotics</subject><subject>Benzodiazepines</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Beta blockers</subject><subject>Brain Injuries, Traumatic - complications</subject><subject>Brain Injuries, Traumatic - drug therapy</subject><subject>Electronic medical records</subject><subject>Haloperidol</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Methylphenidate</subject><subject>Original</subject><subject>Patients</subject><subject>Psychomotor Agitation - drug therapy</subject><subject>Psychomotor Agitation - etiology</subject><subject>Psychotropic drugs</subject><subject>Statistical analysis</subject><subject>Traumatic brain injury</subject><subject>Virginia</subject><subject>Withdrawal</subject><issn>0269-4727</issn><issn>1365-2710</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp9kl2L1DAUhoMo7uzqjT9AAt7Iwuzmq830SpbBTxYUXL0Np2naydA2NWl3mH_kz_R0ZlzUC3OT8L5PXs7hHEJecHbF8Vxv7TBecakz9YgsuMyzpdCcPSYLJvJiqbTQZ-Q8pS1jLNdCPiVnyCgpMrUgP29o5ZKNfhj9vaPQQ7tPPtFQ02EDsQMb2tB4Cy3t0Gxc5_pxdqFpokvJhx4_VdchouJHGGfB93TAF5KJ7vy4oWOEqUPF0jKCn4HtFPczB_RrmMbNzqWRfvex8b0H1E_f6RCGqT2EPiNPamiTe366L8i3d2_v1h-Wt5_ff1zf3C6tUoVaAva4ghocr4q8AF46m7lCCFepSjpZOFmqrODCScR5WRZZXktdrUqOXI32BXlzzB2msnOVxSoitGaIvoO4NwG8-dvp_cY04d5wxlY65xITXp8SYvgxYWOm88m6toXehSkZoTPNMqVVjuirf9BtmCLO4EDlSkvBC6Quj5SNIaXo6odqODPzBph5A8xhAxB--Wf9D-jvkSPAj8DOt27_nyjzaf3l7hj6CyPUwZc</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Rahmani, Elham</creator><creator>Lemelle, Tricia</creator><creator>Sharp, Hunter</creator><creator>Smarbafzadeh, Ehsan</creator><creator>Kablinger, Anita</creator><general>Hindawi Limited</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5246-9965</orcidid></search><sort><creationdate>202212</creationdate><title>A descriptive analysis of pharmacological management of aggression and/or agitation in patients with traumatic brain injury in a Southwest Virginia inpatient population</title><author>Rahmani, Elham ; Lemelle, Tricia ; Sharp, Hunter ; Smarbafzadeh, Ehsan ; Kablinger, Anita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4494-a0068afae1d969a1bec5e922ed4d3e39e3b45912e34491bb956f37d8b1c5ef9e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Adult</topic><topic>Aggression</topic><topic>Aggression - psychology</topic><topic>Agitation</topic><topic>Amantadine</topic><topic>Amantadine - therapeutic use</topic><topic>Anticonvulsants - therapeutic use</topic><topic>Antipsychotic Agents - therapeutic use</topic><topic>Antipsychotics</topic><topic>Benzodiazepines</topic><topic>Benzodiazepines - therapeutic use</topic><topic>Beta blockers</topic><topic>Brain Injuries, Traumatic - complications</topic><topic>Brain Injuries, Traumatic - drug therapy</topic><topic>Electronic medical records</topic><topic>Haloperidol</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Methylphenidate</topic><topic>Original</topic><topic>Patients</topic><topic>Psychomotor Agitation - drug therapy</topic><topic>Psychomotor Agitation - etiology</topic><topic>Psychotropic drugs</topic><topic>Statistical analysis</topic><topic>Traumatic brain injury</topic><topic>Virginia</topic><topic>Withdrawal</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rahmani, Elham</creatorcontrib><creatorcontrib>Lemelle, Tricia</creatorcontrib><creatorcontrib>Sharp, Hunter</creatorcontrib><creatorcontrib>Smarbafzadeh, Ehsan</creatorcontrib><creatorcontrib>Kablinger, Anita</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical pharmacy and therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rahmani, Elham</au><au>Lemelle, Tricia</au><au>Sharp, Hunter</au><au>Smarbafzadeh, Ehsan</au><au>Kablinger, Anita</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A descriptive analysis of pharmacological management of aggression and/or agitation in patients with traumatic brain injury in a Southwest Virginia inpatient population</atitle><jtitle>Journal of clinical pharmacy and therapeutics</jtitle><addtitle>J Clin Pharm Ther</addtitle><date>2022-12</date><risdate>2022</risdate><volume>47</volume><issue>12</issue><spage>2083</spage><epage>2090</epage><pages>2083-2090</pages><issn>0269-4727</issn><eissn>1365-2710</eissn><abstract>What Is Known and Objective
Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In a previous study, we reviewed the literature to identify evidence‐based pharmacological agents for treatment of agitation in TBI. Based on the results of our previous study that summarizes the findings of several systematic reviews, the use of haloperidol and benzodiazepines is not supported by the available evidence while the use of amantadine, beta blockers, antiepileptics and methylphenidate is supported by the limited available evidence. In this study, we describe the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in southwest Virginia. We will also compare the psycho‐pharmacological agents ordered before and after psychiatric consultation.
Methods
Adult patients who were admitted to Carilion Clinic's inpatient facilities from March 30, 2013, to March 30, 2018, had a diagnosis of TBI, and received psychiatric consultation for agitation and/or aggression were enrolled in this study. A retrospective review of electronic medical records was conducted by researchers and data were collected on the following measures: ordered psycho‐pharmacological agents, frequency, dosing and duration of orders, whether each administered psycho‐pharmacological agent was started before or after psychiatric consultation, and psycho‐pharmacological agents prescribed upon discharge.
Results and Discussion
About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence such as amantadine, beta blockers or antiepileptics. The percentage of patient‐days with an order to receive typical antipsychotics significantly decreased following psychiatric consultation (p = 0.0056), but the percentage of patient‐days with an order to receive benzodiazepines significantly increased following psychiatric consultation (p = 0.0001). This finding remained statistically significant after excluding patients with active or unclear alcohol/benzodiazepine withdrawal (p < 0.0001).
What Is New and Conclusion
This study demonstrates the widespread use of typical antipsychotics and benzodiazepines in the management of agitation in TBI and the importance of multidisciplinary collaboration, research and education of providers to improve patient care.
Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In this study, we examined the psycho‐pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non‐profit health care system in Southwest Virginia. About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence. Percentage of patients who received each group of psycho‐pharmacological agents. Non‐recommended = Patients who received benzodiazepines OR typical antipsychotics. Recommended = Patients who received amantadine OR beta blockers (propranolol and pindolol) OR methylphenidate OR valproic acid OR carbamazepine. Atypical antipsychotics = Patients who received atypical antipsychotics that can be considered an acceptable alternative for management of acute agitation in TBI based on available evidence. Multiple medication groups = Patients who received all mentioned medication groups. Did not receive = Patients who did not receive any of the medications of interest.</abstract><cop>England</cop><pub>Hindawi Limited</pub><pmid>36543254</pmid><doi>10.1111/jcpt.13754</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5246-9965</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Journal of clinical pharmacy and therapeutics, 2022-12, Vol.47 (12), p.2083-2090 |
| issn | 0269-4727 1365-2710 |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Adrenergic beta-Antagonists - therapeutic use Adult Aggression Aggression - psychology Agitation Amantadine Amantadine - therapeutic use Anticonvulsants - therapeutic use Antipsychotic Agents - therapeutic use Antipsychotics Benzodiazepines Benzodiazepines - therapeutic use Beta blockers Brain Injuries, Traumatic - complications Brain Injuries, Traumatic - drug therapy Electronic medical records Haloperidol Humans Inpatients Methylphenidate Original Patients Psychomotor Agitation - drug therapy Psychomotor Agitation - etiology Psychotropic drugs Statistical analysis Traumatic brain injury Virginia Withdrawal |
| title | A descriptive analysis of pharmacological management of aggression and/or agitation in patients with traumatic brain injury in a Southwest Virginia inpatient population |
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