The acute period of recovery from traumatic brain injury: posttraumatic amnesia or posttraumatic confusional state?

Object. The goal of this study was to characterize more fully the cognitive changes that occur during the period of acute recovery after traumatic bra in injury (TBI). Methods. The pattern of performance recovery on attention and memory tests was compared with the results of the Galveston Orientation and Amnesia Test (GOAT). Tests of memory and attention were administered serially to a hosp italized group of patients with TBI of varying severity. The tests differed in their level of complexity and/or requirement for more effortful or stra tegic processing. The authors found a regular pattern to recovery. As expec ted, ability to perform on simpler tests was recovered before performance o n more effortful ones. The ability to recall three words freely after a 24- hour delay (the operational definition in this study of return to continuou s memory) was recovered last, later than normal performance on the GOAT. Ab ility to perform simple attentional tasks was recovered before the less dem anding memory task (recognition); ability to perform more complex attention al tasks was recovered before the free recall of three words after a 24-hou r delay. This recovery of attention before memory was most notable and dist inct in the group with mild TBI. Conclusions. The period of recovery after TBI, which is currently termed po sttraumatic amnesia, appears to be primarily a confusional state and should be labeled as such. The authors propose a new definition for this acute re covery period and argue that the term posttraumatic confusional state shoul d be used, because it more appropriately and completely characterizes the e arly period of recovery after TBI.