Role of agitation in prediction of outcomes after traumatic brain injury

Objective: To determine the role of agitation in the prediction of traumati c brain injury rehabilitation outcomes. Design: A longitudinal study of 340 consecutive patients admitted to an acu te traumatic brain injury rehabilitation unit was conducted. Outcomes under study included rehabilitation length of stay, discharge destination, funct ional independence at discharge (FIM (TM) instrument), productivity at 1-yr follow-up, and life satisfaction at 1-yr follow-up (Satisfaction with Life Scale). Results: Univariate analyses suggested that the presence of agitation in re habilitation is predictive of a longer length of stay and decreased functio nal independence in the cognitive realm at discharge. In addition, individu als who exhibit agitation at any time during rehabilitation are less likely to be discharged to a private residence. However, multivariate analyses in dicated that cognitive functioning at admission to rehabilitation (FIM cogn itive) mediates the relationship between the presence of agitation and leng th of rehabilitation, as well as between agitation and FIM cognitive at dis charge. Similar results were found when discharge residence was the depende nt variable; however, agitation also contributed some unique variance to th e prediction. Lower cognitive functioning at admission to rehabilitation wa s associated with the occurrence of agitation during rehabilitation, longer length of stay, lower cognitive functioning at discharge, and a decreased likelihood that an individual would be discharged to a private residence. Conclusions: The results of the multivariate analyses support the contentio n that agitation and cognition are intimately related, with the long-term e ffects of the former being at least partially driven by the latter. These f indings support the importance of systematically monitoring both agitation and cognition when applying interventions to reduce agitation.